Anti-inflammatories - corticosteriods

Question 1

List 2 clinical applications of Corticosteroids…

Answer 1

• Replacement in adrenal insufficiency (ADDISONS DISEASE)
• Induce parturition (used with PGF2α)
• Supraphysiologic (to help with ketosis)
• Supraphysiologic to supress: allergy, inflam.

Question 2

What is ADT?

Answer 2

Alternate day therapy - method for achieving LOWEST POSSIBLE DOSE THAT IS STILL THERAPEUTIC

Question 3

Frequency & clinical signs of glucocorticoid side-effects…

Answer 3

Early (days to weeks) - common:
- polyuria & polydipsia; weight change; transient adrenal suppression
Late (month to years)
Common:
- central obesity; hair loss; prolongued adrenal suppression; hypertension
Sporadic:
- cataracts

Question 4

the steroids that are produced by…

Answer 4

adrenal cortex

Question 5

3 synthetic steroids with corticosteroid-like effects…

Answer 5

• prednisolone
• dexamethasone
• methylprednisolone

Question 6

GLUCOCORTICOIDS relate to what? eg?

Answer 6

corticosteroids predominantly produced by the ZONA FASCICULATA eg cortisol

Question 7

MINERALOCORTICOIDS relate to what? eg?

Answer 7

corticosteroids predominantly produced by the ZONA GLOMERULOSA eg. aldosterone

Question 8

Main corticosteroids involved in “stress”?

Answer 8

glucocorticoids

Question 9

glucocorticoids MOA… draw!

Answer 9

slide 20

Question 10

What are the inflammatory & immune responses of Glucocorticoids…?

Answer 10

inflamm: Inhibit Phospholipase A2 -> decrease Arachidonic Acid -> supresses COX- I & II & LOX synthesis -> decrease PGEs & leukotrienes
immune: decrease cell-mediated immunity

Question 11

What are some secondary anti-inflammatory effects of Glucocorticoids…?

Answer 11

breaks a fever - decreased pyrogenic response to inflammation
affect chronic inflam - decreased macrophages at site of inflamm
anti-allergy - decrease immediate hypersensitivity response

Question 12

Most of the anti-inflammm effects of glucocorticoids are primary or secondary effects?

Answer 12

secondary effects

Question 13

What are some Glucocorticoid side effects…?

Answer 13

1. metabolic
2. immune - suppression
3. CV - hypertension
4. NSAID SEs

Question 14

What are some NSAID SEs caused by Glucocorticoids…?

Answer 14

GIT ulceration - ↓PGE & ↓PGI2
Kidney failure - ↓PGE & ↓PGI2
Altered platelet function - ↓PGI2 & ↓TXA2

Question 15

Name 2 common ‘FRONTLINE’ glucocorticoids used in smallies…indications?

Answer 15

• prednisolone tabs, VERY COMMONLY USED for many skin conditions
• pred IV not very common as high $ DOA:24-36hrs

Question 16

Name an overused & misused glucocorticoid

Answer 16

Dexamethasone - in smallies DOA 72hrs
Wrongly used for shock & skin conditions
can be used in other animals eg. largies

Question 17

Name a potent & long-acting steroids…

Answer 17

1. Methylprednisolone (depo-medrol) common in smallies
   CHRONIC SKIN COND’S
   DOA: 2-4 weeks
   Multiple yearly injections -> [HPA] suppression
   NOT IV!!!

Question 18

Name 2 topical seroids…

Answer 18

1. neocort - hydrocortisone acetate, neomycin & lignocaine
   used for symptomatic relief
   prob: gets licked off
2. Dermapred - prednisolone + other stuff
   thick green goo commonly used in horse skin wounds

Question 19

Steroid ear treatment?

Answer 19

‘Dermotic’ - prednisolone + other stuff -> antibacterial, antifungal, anti-inflam & antipruritic (anti-itch).