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Pharmacology > Chapter 11 Corticosteroids > Flashcards

Chapter 11 Corticosteroids Flashcards

1
Q

Two RRT drugs sound alike- pulmicort and pulmozyme. Which is a corticosteroid?

A

pulmicort

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2
Q

What are the clinical indications for the use of inhaled corticosteroids?

A

Step 2 asthma

COPD (to increase responsiveness of beta agnonist receptors)

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3
Q

Where are endogenous corticosteroids produced?

A

in the adrenal cortex

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4
Q

How do corticosteroids work in the treatment of asthma?

A

mediates the body’s inflammatory response

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5
Q

Briefly describe the role of antigens in the inflammatory process

A

Antigen enters respiratory tract and stimulates formation of antigen-specific antibody (IgE) on mast cell. Upon re-exposure to the antigen, the body’s antigen-antibody complex is activated and stimulates rupture of mast cells (degranulation) releasing the chemical mediators (histamines and other chemicals) that cause inflammation.

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6
Q

What are the clinical symptoms associated with inflammatory response in the lung?

A

wheezing, shortness of breath, cough, tightness, hypoxemia

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7
Q

Which type of asthma is the most common (according to Denise’s powerpoint)

A

allergic asthma

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8
Q

What is the preferred method of treatment for allergic asthma?

A

immunotherapy (identifying and desensitizing to the specific triggering allergan)

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9
Q

T/F In non allergic asthma, there is no immune system response

A

true

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10
Q

Name 3 triggers for non-allergic asthma

A

cold air, exercise, stress, infection

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11
Q

What is involved in the early-phase inflammatory response?

A

local vasodilation; increased vascular permeability; redness, swelling
(further in asthma bronchial contraction as a result of mast cell degranulation)

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12
Q

When does late-phase inflammatory response occur?

A

6-8 hours after initial exposure

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13
Q

What happens during late state inflammatory response?

A

leukotrienes and prostaglandins are released leading to mucosal edema, increased mucus production, mucus plugging and hyperreactivity of the airways and increased vascular permeability

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14
Q

Treatment is aimed at stopping inflammatory progression at what stage?

A

the earlier the better- late stage inflammatory response is much more difficult to resolve

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15
Q

T/F Bronchodilators will help mediate the inflammatory response.

A

False. they reverse bronchospasm but don’t touch inflammation

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16
Q

What effect does cromyln sodium have on mast cells?

A

it prophylactically coats mast cells to prevent them from degranulating

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17
Q

What is the function of the hypothalamic pituitary adrenal axis?

A

It is the pathway for the release and control of corticosteroids

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18
Q

T/F The body distinguishes between endogenous and exogenous steroids.

A

False. The body CANNOT distinguish them

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19
Q

Administration of glucocorticoid drugs inhibits the body’s production of glucocorticoid drugs by inhibiting the ______ and ____ glands

A

hypothalamus and pituitary glands

20
Q

What effect do corticosteroids have on blood sugar levels?

A

causes them to rise- can cause steroid induced diabetes

21
Q

Production of the body’s own glucocorticoids follows a rhythmic cycle called what?

A

the diurnal steroid cycle (or circadian rhythm)

22
Q

Cortisol levels in the body are highest when?

A

8 am

23
Q

What dosing regimen will maintain the body’s endogenous production of glucocorticoids?

A

alternate-day steroid therapy- giving steroids early am every other day will sync with the body’s HPA system

24
Q

What causes the redness in inflammatory reactions?

A

local dilation of blood vessels (it occurs in seconds)

25
Q

What is involved in the body’s “triple response” to inflammation

A

redness, flare (reddish color several centimeters from the site occuring within 15 to 30 seconds) and wheal- local swelling that occurs in minutes

26
Q

With increased vascular permeability an exudate is formed in the surrounding tissues. ___ ____ ____ emigrate through the leaky vessels in response to attractant chemicals in a process called _____.

A

white blood cells; chemotaxis

27
Q

List the components of patient education that should be undertaken when corticosteroid treatment has been prescribed

A

Patient should understand how to take the medicine, that a spacer is important when being administered via MDI, that rinse and spit is important to avoid disruption of normal flora and overgrowth of fungus resulting in thrush; that steroids ARE NOT rescue medications. Patient should be instructed on use of peak flow to monitor their peak expiratory flow and have a written asthma plan based on PFM results and their symptoms.

28
Q

What are potential systemic side effects from corticosteroid use?

A

renal insufficiency, acute asthma, HPA suppression, growth retardation, osteoporosis, high blood glucose, and tiny testicles :)

29
Q

What are potential side effects from inhaled corticosteroids?

A

oropharyngeal fungal infections; hoarseness, vocal disturbances, cough, bronchoconstriction

30
Q

Adrenal suppression is not seen in doses under what level?

A

under 800 micrograms

31
Q

What is the dosage/ route for Flunisolide (AeroSpan)

A

MDI: 80 ug/per puff - 2 puffs twice daily

32
Q

What is the dosage/route for Fluticasone (Flovent)

A

MDI: 44, 110, 220 ug puff (dosage varies) 2 x day

33
Q

What is the dosage/route for Budesonide (Pulmicort)?

A

DPI: 90 or 180 ug per actuation or

0.5 mg/2ml nebulized 2x daily

34
Q

What is the dosage for Fluticasone/Salmeterol (Advair)

A

DPI: 100/50; 250/50; 500/50 (ug)

fluticasone/salmeterol twice daily

35
Q

What is the dosage/route for Budesonide/formoterol (Symicort)

A

MDI 80/4.5; 160/4.5 twice daily

36
Q

T/F Steroids increase B2 adrenergic receptor transcription

A

true

37
Q

T/F Inhaled corticosteroid therapy can provide partial protection against development of adrenergic tolerance

A

true

38
Q

T/F Salmeterol has been shown to promote binding of the glucocorticoid receptor to the response element of the cell’s nuclear DNA

A

true

39
Q

What are some hazards/complications associated with oral steroid burst therapy or IV steroids?

A 
suppression of HPA axis
immunosuppression
psychiatric reactions
cataract formation
cushing syndrome
peptic ulcer
fluid retention
hypertension
increased WBC count
dermatological changes
slowing of growth in children
hyperglycemia
loss of bone density
40
Q

What are some systemic side effects that can be seen with aerosol administration?

A

adrenal insufficiency
allergic inflammation after cessation
suppression of HPA function
growth reduction in children

41
Q

What are some topical/local side effects seen with aerosol administration?

A 
oral thrush (candidiasis)
dysphonia (hoarseness)
42
Q

How can you reduce topical local side effects?

A

use minimal doses
use reservoir
rinse and spit after use

43
Q

Clinical application of aerosol steroids includes:
I early use in asthma
II for acute severe asthma
III for relief of symptoms in COPD patients
IV To improve FEV1 in COPD patients

A. i & II
B. I & III
C. I, II & III
D. I, II, III and IV

A

the answer is C

44
Q

What are some of the benefits of daily corticosteroid use?

A

most effective inhaled medication for long term control of persistent asthma;
improves bronchial hyperresponsiveness over time;
to prevent and reverse airway remodeling
to reduce symptoms and inflammation
to reduce the number of severe exacerbations

45
Q

Why should oral steroids be tapered down when discontinuing therapy?

A

to give the body the chance to normalize and resume its production of endogenous corticosteroids

46
Q

What are some symptoms of steroid withdrawal?

A

anorexia, nausea, vomiting, lethargy, headache, hypotension

Pharmacology (14 decks)

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