Corticosteroids (Nursing)

00:01 So, corticosteroids.

00:03 Look, they helped you there but they've made those letters red, C-O-R-T.

00:08 Just underline that in corticosteroids to help reinforce that concept in your brain.

00:13 Corticosteroids are a class of steroid hormones, and they are produced in the adrenal cortex.

00:19 So underline it there too.

00:20 Just underscore those in your notes that helps stand out in your brain that these are coming from the adrenal cortex.

00:28 Now, there's a long, long list of things that these corticosteroids are involved in.

00:35 Let me tell you, they're playing a big role in nursing school for you because most of us are stressed when we're going back to school.

00:42 Corticosteroids play a big role in that.

00:45 Remember, they'll mess with your immune response, so the higher the level of corticosteroids, the more we're going to suppress that immune response, and that's important to remember.

00:55 Because if your patient is on some high dose of corticosteroids, they're almost immunocompromised in some ways, because it regulates inflammation.

01:04 So, keep that in mind, kind of write yourself a note that when they're on high dose corticosteroids for a long period of time, it's going to suppress inflammation.

01:13 Now, we come down to carb metabolism and protein metabolism.

01:17 That definitely plays a role when you guys are in nursing school and under stress.

01:22 You have higher levels of the hormones that are going to make you tend to put on weight right around the middle.

01:29 Now, blood electrolyte levels can also be impacted by corticosteroids.

01:34 It starts involving that sodium with aldosterone that you've heard us talk about before.

01:40 And lastly, you can end up with some real mood changes and behavior changes when someone is on corticosteroids.

01:47 Now, for any one of these things, corticosteroids in my body at normal levels, they manage my stress response, my immune response, inflammation, how I metabolize carbs and proteins, my blood electrolyte levels, and it helps me kind of modulate mood.

02:03 So when I take a medication that's a corticosteroid, all of these have the opportunity to be impacted.

02:10 So, let's talk about the specific hormones.

02:13 What are those plays that the coach sets in and what's the football like that the quarterback throws down the field? So, when the hypothalamus -- picks up from the rest of your body, "Hey, I've got this information, and I think we need more corticosteroids." It will put out or produce corticotropin-releasing hormone.

02:37 Okay.

02:38 "Cort" means its target and we're heading for -- we want the corticosteroids, right? We want the adrenal cortex to make, that's what tropin says, releasing hormone.

02:51 So the play the hypothalamus is sending in is that we need more corticosteroids.

02:56 So, the corticotropin-releasing hormone is uniquely structured so it connects and binds in the anterior pituitary gland.

03:06 So when the anterior pituitary -- remember that? That's part of that pea-size master gland, when it receives CRH, then it puts out adrenocorticotropic hormone.

03:21 Now, let's break down that word.

03:22 Underline A-D-R-E-N, that means, the target is the adrenal gland.

03:28 Now, C-O-R-T tells me the target is specifically the cortex of the adrenal gland.

03:34 Tropic, that means put it out.

03:37 Hormone means messenger.

03:39 So, when the hypothalamus senses that we need more corticosteroids, it sends the message CRH to the anterior pituitary.

03:49 When the anterior pituitary gets that message, it sends another message out, just like a quarterback sending a football down the field.

03:58 It sent a message out in the form of adrenocorticotropic hormone.

04:04 Remember what our target is, adrenal cortex.

04:08 So, the adrenal cortex receives that ACTH and it releases cortisol and aldosterone.

04:17 So you got that? Let's walk through that 1 more time.

04:20 The hypothalamus senses we need more corticosteroids, like cortisol and aldosterone.

04:27 So, the coach sends the play in.

04:29 The hypothalamus sends CRH and it hits the anterior pituitary, uniquely fitted so it only will get -- send the message to the anterior pituitary.

04:41 When the anterior pituitary receives CRH, it sends out ACTH.

04:46 Target? Adrenal cortex.

04:49 Adrenal cortex receives the ACTH, catches that ball, and put out adrenal cortex, adrenal corticosteroids, cortisol, and aldosterone.

05:00 Okay, now.

05:01 You might think, "What in the world are we doing going through all these steps?" Well, these make a huge difference in you understanding the types of diseases that we treat with corticosteroids, how they're helpful, and what the risks are.

05:16 So, really, it's not that complicated if you think of it in this format.

05:22 We're involving CRH, ACTH, and then we end up with cortisol and aldosterone.

05:29 Now, there are 2 types of corticosteroids, right? We just talked about those, but there are mineralcorticoids and glucocorticoids.

05:40 Okay, they've both got that CORT in the middle, and you'll see we've made that big, capitalized, and red for you to remind you that mineralcorticoids and glucocorticoids come from the adrenal -- Right, cortex.

05:55 Okay.

05:56 So, an example of a mineralcorticoid is aldosterone, right? So, aldosterone tells my body, "Hey --" When that gets secreted, my body gets the message to know, "Hey, hang on to sodium.

06:11 Reabsorb that sodium." Now, wherever sodium goes, water follows, okay? So, anytime I hang on to sodium, I'm going to also hang on to more water, I'm going to have more volume in my body, and my blood pressure is going to go up.

06:27 Now, glucocorticoids are things like cortisol.

06:30 Now, that's usually what we're looking after.

06:33 That's what we want with most patients when we're giving them corticosteroids.

06:37 Now, if someone's adrenal gland is completely shot, we're going to have to replace all the hormones of the adrenal gland.

06:44 But usually, we're giving corticosteroids because we want this glucocorticoid portion.

06:51 Okay, so the adrenal cortex really puts out mostly cortisol, but sometimes, it also puts out the aldosterone.

06:58 We just see more cortisol in your body.

07:01 Now, we talked about what aldosterone does, right? I use that funny word, aldosterone, just because it's annoying and I know it will stick in your brain better.

07:11 That promotes sodium retention in the kidneys.

07:14 Before we move on, can you answer this question? How does promoting sodium retention by the kidneys impact my vital signs? Okay, good.

07:32 Hopefully, you remembered that when you absorb more sodium, you'll also -- water will follow, and when I have more volume on board, my blood pressure -- that's the vital sign that will be impacted -- my blood pressure will be elevated.

07:47 Now, cortisol gets a little more personal, right? It controls my carb, fat, and protein metabolism.

07:55 This is the one that helps me put weight on right around my middle where nobody wants it.

08:01 It's also an anti-inflammatory.

08:03 So, if I'm having a major inflammatory response, this will help suppress that.

08:08 It stops phospholipid release, and it also decreases eosinophil action.

08:13 So that's all helping me with that inflammatory response.

08:17 So, aldosterone is the sodium, but cortisol, carb, fat, and protein metabolism, and really focus on that anti-inflammatory effect because that's what we want.

08:29 When we give corticosteroids, that's predominantly what our goal is, so make sure you circle anti-inflammatory and star that.

08:36 So remember, that's usually what we're after.

08:39 That's the therapeutic thought.