Adrenocorticosteroids

Question 1

Short to Medium-Acting Steroids

Answer 1

Hydrocortisone
Cortisone
Prednisone
Prednisolone
Methylprednisolone

Question 2

Intermediate Acting Steroids

Answer 2

Triamcinolone

Question 3

Long Acting Steroids

Answer 3

Betamethasone

Dexamethasone

Question 4

Mineralocorticoids

Answer 4

Fludrocortisone

Desoxycorticosterone

Question 5

Addison’s Dz Tx

Answer 5

Hydrocortisone (20-30 mg/day) plus fludrocortisone

For acute episodes, parenteral hydrocortisone at high dose (100 mg every 8 hours, then reduce gradually)

Question 6

CAH infant should be treated with what?

Answer 6

Hydrocortisone

Question 7

Cushing’s Syndrome Tx

Answer 7

Surgical removal of tumor

Bilateral adrenalectomy

High dose hydrocortisone coverage for perioperative period

Long term maintenance and mineralocorticoid use in patients who have undergone adrenalectomy

Question 8

Primary Aldosteronism Tx

Answer 8

Spironolactone (potassium sparing, aldosterone receptor blocking agent), and txt underlying cause

Question 9

Dexamethasone Suppresion Test

Answer 9

Single dose 8mg given at 11pm

Non-barbiturate hypnotic agent given (barb=false +)

Plasma cortisol and urine 17-OHCS levels measured in the morning

Suppression indicates ACTH origin

Lack of suppression suggests presence of tumor in adrenal gland.

Question 10

Tx for infant preterm delievery and why is it chosen?

Answer 10

Betamethasone given as it decreases the chances of respiratory distress.

Chosen as drug for pregnancy because there is less binding to maternal globulin which leads to increased amount crossing the placenta (why this drug is chosen)

Question 11

Tx for Non-Adrenal Disorders including Inflammatory and immune-mediated disease such as
Asthma and RA

Answer 11

Medium-acting corticosteroids:
Prednisone, prednisolone, methylprednisolone
Do not stop therapy abruptly, always taper down

Note: these are not curative, just suppressive

Question 12

Steroid ADE

Answer 12

Metabolic:
Fat deposits, hyperglycemia, impaired wound healing, muscle wasting, myopathy

Other complications:
Gastric ulceration, bacterial and fungal infections, can worsen (prob not cause) psychiatric disorders (hypomania, depression), cataract development, Sodium and fluid retention, hypokalemia

Adrenal suppression

Question 13

ACTH or Corticosteroids?

Answer 13

Corticosteroids! ACTH is too non-specific

Question 14

Steroid Dosage Forms

Answer 14

Oral tablets and solution
Injectable (solution and suspension)
Inhalers, nasal sprays (Asthma/Rhinitis)
Topical preparations (rash)

Note: Dosage depends upon the condition treated

Question 15

Mifepristone (RU-486)

Answer 15

Strong antiprogestin activity

High doses block the glucocorticoid receptor, inhibiting activation

Able to reverse many of the symptoms associated with Cushing’s Syndrome

Recommended for inopperable patients with ectopic ACTH secretion or adrenal tumors.

Question 16

Spironolactone

Answer 16

Mineralocorticoid Antagonist and also an androgen antagonist

Weak K-sparing diuretic, hirsutism, aldosteronism

Question 17

Eplerenone

Answer 17

A mineralocorticoid antagonist, no antiandrogenic effects

Question 18

Drospirenone- progestin (Yasmin, Yaz, etc)

Answer 18

A mineralocorticoid anatagonist that counteracts estrogen-induced stimulation of RAAS