Anti-Inflammatory Corticosteroids

Question 1

What is hydrocortisone’s:

• Anti-inflammatory activity

Answer 1

1

Question 2

What is hydrocortisone’s:• Topical activity

Answer 2

1

Question 3

What is hydrocortisone’s:• Salt retaining activity

Answer 3

1

Question 4

What is hydrocortisone’s:• Potency

Answer 4

20

Question 5

What is hydrocortisone’s:• Routes of administration?

Answer 5

oral, injectable, topical

Question 6

What is prednisone’s • Anti-inflammatory activity

Answer 6

4

Question 7

What is prednisone’s • Topical activity

Answer 7

0

Question 8

What is prednisone’s • Salt retaining activity

Answer 8

0.3

Question 9

What is prednisone’s • Potency

Answer 9

5

Question 10

What is prednisone’s • Routes of administration?

Answer 10

oral

Question 11

What is metylprednisolone’s topical activity

Answer 11

5

Question 12

What is metylprednisolone’s salt retaining activity

Answer 12

5

Question 13

What is metylprednisolone’s potency

Answer 13

0

Question 14

What is metylprednisolone’s routes of administration

Answer 14

Oral and injectable

Question 15

What is metylprednisolone’s anti-inflammatory activity

Answer 15

Four

Question 16

What is Triamcinolone’s:

• Anti-inflammatory activity

Answer 16

5

Question 17

What is Triamcinolone’s:• Topical activity

Answer 17

5^3

Question 18

What is Triamcinolone’s: • Salt retaining activity

Answer 18

0

Question 19

What is Triamcinolone’s: • Potency

Answer 19

4

Question 20

What is Triamcinolone’s: • Routes of administration?

Answer 20

oral, injectable, topical

Question 21

What is Dexamethasone’s:

• Anti-inflammatory activity

Answer 21

30

Question 22

What is Dexamethasone’s: • Topical activity

Answer 22

10

Question 23

What is Dexamethasone’s: • Salt retaining activity

Answer 23

0

Question 24

What is Dexamethasone’s: • Potency

Answer 24

0.75

Question 25

What is Dexamethasone's: • Routes of administration?

Answer 25

oral, injectable, topical

Question 26

What are the 5 corticosteroid drugs that Dr. French would like us to know?

Answer 26

Hydrocortisone, prednisone, methylprednisolone, triamcinolone, dexamethasone

Question 27

What's the goofy pneumonic I use to keep track of the 5 corticosteroid drugs I should know about?

Answer 27

``` H - Hyper (Hydrocortisone) P - Pigs (Prednisone) M - Mangle (Methylprednisolone) T - Tomatoes (Triamcinolone) D - Dramatically (Dexamethasone) ```

Question 28

Which of the 5 drugs we are supposed to know are able to be used topically?

Answer 28

H, T, D (Hydrocortisone, Triamcinolone, Dexamethasone). All of these drugs have a 0 in the salt retaining category, which has to do with Mineralocorticoid activity

Question 29

Where in the pathway of prostaglandin and leukotriene synthesis do Glucocortocoids work?

Answer 29

UPSTREAM, they inhibit phospholipase A2, which inhibits the production of Arachidonic Acid, the precursor to both leukotrienes and prostaglandins

Question 30

What is the primary gland affected by chronic GC use?

Answer 30

Adrenal gland. With chronic GC use you can get adrenal atrophy and Iatrogenic Cushing's

Question 31

What are the main scary/concerning side effects in mineralocorticoids?

Answer 31

Hypertension, Hypokalemia (low potassium) Metabolic Alkalosis

Question 32

What are the PHYSIOLOGIC (not pharmocologic) Metabolic effects of Glucocorticoids?

Answer 32

Carbohydrates, Protein, Fat (increase gluconeogenesis and blood glucose, leading to increased insulin), (decreased protein synthesis as a result of more amino acids made into glucose), (increased lipolysis in the periphery and a resultant increase in free fatty acids)

Question 33

What is the PHARMACOLOGIC Metabolic effects of excess GC use?

Answer 33

Carbohydrate, Protein, Fats, Sodium reabsorption (diabetes like state), (muscle wasting and skin/connective tissue atrophy), (increased lipogenesis centrally leading to centripetal obesity seen in moon facies, buffalo hump), (sodium-fluid retention, hypertension, hypokalemia, metabolic alkalosis) ALL THIS LEADING TO IATROGENIC CUSHINGS DISEASE

Question 34

What adverse effect can GC use have on the fluid retention system on the body?

Answer 34

Can lead to sodium reabsorption at kidney and thus fluid retention (normally helps increase blood volume and blood pressure). IN EXCESS, you see hypertenstion, hypokalemia (body getting rid of K to compete with increased Na) and metabolic alkalosis

Question 35

What is GC effect on vascular events systemically?

Answer 35

reduced vasodilators (prostaglandins), decreased fluid exudation

Question 36

What is the GC effect on cellular events?

Answer 36

overall decrease in accumulation-activation of inflammatory and immune cells

Question 37

What is the GC systemic effec on inflammatory and immune mediator production?

Answer 37

overall DECREASE in production of inflammatory mediators

Question 38

For a GC chemical to properly work, what Carbon need have an OH group?

Answer 38

11'. The 11-Carbon position needs to have an OH. If it doesn't, it first needs to be metabolized into having the OH at that position (it is likely an 11-KETO)

Question 39

can you use GC in pregnancy without affecting fetus

Answer 39

yes, depending on agent (needs to avoid fetal enzyme)

Question 40

why is prednisone so commonly prescribed?

Answer 40

Oral administration, and 5:1 GC:MC action

Question 41

which of the GC's we are supposed to know is the most potent anti-inflammatory?

Answer 41

Daxamethasone

Question 42

How are GC's usually used in RA treatment?

Answer 42

As the "bridge" between NSAID and DMARD use. Use as low dose therapy

Question 43

What is the primary clinical benefit to the alternate day glucocorticoid regimen?

Answer 43

Minimizes clucocorticoid block of ACTH release which can significantly reduce adrenal atrophy