★Vocabulary★
corticosteroid – n. 皮质甾类，皮质类固醇
androgen – n. 难激素
glucocorticoid – n. 糖皮质激素
mineralocorticoid – n. 盐皮质激素
adrenocortical agents – 肾上腺皮质药
hydrocortisone – n. 氢化可的松
cortisone – n. 可的松
prednisone – n. 泼尼松
retard – v. n. 阻止，迟延
occlude – v. 封闭，关闭，咬合
spray – n. v. 喷雾（剂）
inhalant – n. 吸入剂
excoriated – a. 脱皮的
Corticosteroids Across the Lifespan
不同年龄段人群的皮质甾类治疗
There are three types of corticosteroids: Androgens, glucocorticoids, and mineralocorticoids. Not all adrenocortical agents are classified as only glucocorticoids or mineralocorticoids. Hydrocortisone, cortisone, and prednisone have glucocorticoid and some mineralocorticoid activity and affect potassium, sodium, and water levels in the body when present in high levels.
Corticosteroids are used in children for the same indications as in adults. The dose for children is determined by the severity of the condition being treated and the response to the drug—not on a weight or age formula.
Children need to be monitored closely for any effects on growth and development, and dose adjustments should be made or drug discontinued if growth is severely retarded.
应密切监测儿童是否出现对生长和发育有影响的效应；如果生长严重迟滞，就必须调整剂量或停药。
Topical use of corticosteroids should be limited in children; because their body surface area is comparatively large, the amount of the drug absorbed in relation to weight is greater than in an adult. Apply sparingly and do not use in the presence of open lesions. Do not occlude treated areas with dressings or diapers, which may increase the risk of systemic absorption.
Children need to be supervised when using nasal sprays or respiratory inhalants to ensure that proper technique is being used.
儿童使用鼻喷雾或呼吸吸入剂时必须加以监督，确保使用技术正确。
Children receiving long-term therapy should be protected from exposure to infection, and special precautions should be instituted to avoid injury. If injuries or infections do occur the child should be seen by a primary care provider as soon as possible.
Adults should be reminded of the importance of taking these drugs in the morning to approximate diurnal rhythm.
应提醒成人早晨使用、尽量接近昼夜节律的重要性。
They should also be cautioned about the importance of tapering the drug rather than stopping abruptly.
还应警告成人慢性减少剂量而不是突然停药的重要性。
Several over-the-counter topical preparations contain corticosteroids, and adults should be cautioned to avoid combining these preparations with prescription topical corticosteroids. They also should be cautioned to apply any of these sparingly and to avoid applying them to open lesions or excoriated areas.
With long-term therapy the importance of avoiding exposure to infection — crowded areas, people with colds or the flu, activities associated with injury — should be stressed. If an injury or infection should occur the patient should be encouraged to seek medical care. Monitoring blood glucose levels should be done regularly.
These drugs should not be used during pregnancy because they cross the placenta and could cause adverse effects on the fetus. If the benefit to the mother clearly outweighs the potential risk to the fetus, they should be used with caution. Nursing mothers should find another method of feeding the baby if corticosteroids are needed because of the potential for serious adverse effects on the baby.
Older adults are more likely to experience the adverse effects associated with these drugs, and the dose should be reduced and the patient monitored very closely. Older adults are more likely to have hepatic and/or renal impairment, which could lead to accumulation of drug and resultant toxic effects. They are also more likely to have medical conditions that could be imbalanced by changes in fluid and electrolytes, metabolism changes, and other drug effects. Such conditions include diabetes, heart failure, osteoporosis, coronary artery disease, and immune suppression. Careful monitoring of drug dose and response to the drug should be done on a regular basis.
1. Based on the passage above, the dose of corticosteroids for children is determined by the following. Select all that apply.
A. Severity of the disease
B. Response to the drug
C. Weight of the client
D. Age of the client
2. A 32 year old woman suffering from weight gain, hirsutism, fatigue, hypertension, diabetes and premature osteoporosis is found to have elevated plasma cortisol levels. To determine if her cortisol production is under pituitary control, you attempt to suppress pituitary ACTH production by administering a potent & long-acting synthetic glucocorticoid. Which glucocorticoid would you use for this purpose?
A. cortisone
B. dexamethasone
C. fludrocortisone
D. methylprednisolone
E. prednisolone
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ISPN/RN复习练习、效果检验一站完成。
答案 Answer 1. A, B Rationale: The dose of corticosteroids for children is determined by the severity of the disease being treated and the response to the drug, not on a weight or age formula. 2. B. Dexamethasone Rationale: This patient has signs & symptoms consistent with Cushing's syndrome. The most common cause (60-70% of cases) is a benign pituitary adenoma that secretes increased amounts of ACTH, causing excessive cortisol production by the adrenal gland. This diagnosis is based upon documenting increased cortisol levels, and failure to suppress cortisol secretion when dexamethasone is administered (known as a "dexamethasone test").
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