Adrenal Cortex Flashcards
How potent are prednisolone and dexamethosone compared to Cortisol/Hydrocortisone?
Prednisolone = 4x more potent Dexamethasone = 30x more potent (7.5x more potent than pred)
Which steroid requires hepatic activation?
Prednisone needs to be turned into prednisolone at the liver
What are the short acting steroids? (
Hydrocortisone, Prednisone, Methylprednisone
What the Intermediate acting steroid? (24-48h)
Triamcinolone
What are the long acting steroids? (>48h)
Betamethasone, dexamethasone
What are the two salt esters?
Sodium phosphate and sodium succinate
How do salt esters effect the steroids?
Allow steroids to become soluble for IV injection.
Gives the drugs a faster onset but the same duration as their oral/base steroid.
What are the insoluble esters?
Acetate and Acetonide
What do insoluble esters do to the steroids?
delays the onset of action and duration to allow for a longer absorption.
duration will be much longer than the oral/base steroid.
What steroid cannot become an ophthalmic or dermatologic drug?
Prednisone bc it needs to be change in the liver
What is fluticasone used for?
inhaled glucocorticoid for pulmonary disease
What is Budesonide used for?
To treat GI disease, works locally at GIT then has high first pass metabolism
How are steroids metabolized and excreted?
Widely distributed even to the CNS
highly bound to PP
metabolized to release base steroid
excreted in the urine
What drug should NEVER be used with glucocorticoids???
NSAIDS!!!!
Side effects of glucocorticoids?
Short term: PU/PD, stress leukogram, decreased T3 measurement
Long term: immune suppression, poor wound healing, hypertension, RISK OF ADDISONS
What is the replacement dosing for glucocorticoids?
Pred 0.1-0.22mg/kg/day
What is the anti-inflammatory dosing for glucocorticoids?
Pred 0.5-1mg/kg/day
What is the Immunosuppressive dosing for glucocorticoids?
Pred 2-4mg/kg/day
What is the predominate effect of mineralcorticoids?
essentially aldosterone so Na+ retention.
What are the two mineralcorticoids that we know?
Desoxycorticosterone Pivalate (DOCP) and Fludrocortisone
How do you give DOCP?
Given IM, no glucocorticoid effects, monitor Na+ and K+ levels
How do you give fludrocortisone?
Orally, more potent and has glucocorticoid effect, monitor Na+ and K+ levels
T/F Dexamethasone has less mineralcorticoid effect than prednisolone
True.
So when treating with a steroid in a cardiac dysfunction p, you may want to consider using dex over pred
What drug is the index corticosteroid with meralcorticoid and glucocorticoid activity of ‘1’?
Cortisol/Hydrocortisone
