Chapter 11 Corticosteroids

Question 1

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

Answer 1

pulmicort

Question 2

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

Answer 2

Step 2 asthma

COPD (to increase responsiveness of beta agnonist receptors)

Question 3

Where are endogenous corticosteroids produced?

Answer 3

in the adrenal cortex

Question 4

How do corticosteroids work in the treatment of asthma?

Answer 4

mediates the body’s inflammatory response

Question 5

Briefly describe the role of antigens in the inflammatory process

Answer 5

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.

Question 6

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

Answer 6

wheezing, shortness of breath, cough, tightness, hypoxemia

Question 7

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

Answer 7

allergic asthma

Question 8

What is the preferred method of treatment for allergic asthma?

Answer 8

immunotherapy (identifying and desensitizing to the specific triggering allergan)

Question 9

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

Answer 9

true

Question 10

Name 3 triggers for non-allergic asthma

Answer 10

cold air, exercise, stress, infection

Question 11

What is involved in the early-phase inflammatory response?

Answer 11

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

Question 12

When does late-phase inflammatory response occur?

Answer 12

6-8 hours after initial exposure

Question 13

What happens during late state inflammatory response?

Answer 13

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

Question 14

Treatment is aimed at stopping inflammatory progression at what stage?

Answer 14

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

Question 15

T/F Bronchodilators will help mediate the inflammatory response.

Answer 15

False. they reverse bronchospasm but don’t touch inflammation

Question 16

What effect does cromyln sodium have on mast cells?

Answer 16

it prophylactically coats mast cells to prevent them from degranulating

Question 17

What is the function of the hypothalamic pituitary adrenal axis?

Answer 17

It is the pathway for the release and control of corticosteroids

Question 18

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

Answer 18

False. The body CANNOT distinguish them

Question 19

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

Answer 19

hypothalamus and pituitary glands

Question 20

What effect do corticosteroids have on blood sugar levels?

Answer 20

causes them to rise- can cause steroid induced diabetes

Question 21

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

Answer 21

the diurnal steroid cycle (or circadian rhythm)

Question 22

Cortisol levels in the body are highest when?

Answer 22

8 am

Question 23

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

Answer 23

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

Question 24

What causes the redness in inflammatory reactions?

Answer 24

local dilation of blood vessels (it occurs in seconds)

Question 25

What is involved in the body's "triple response" to inflammation

Answer 25

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

Question 26

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 _____.

Answer 26

white blood cells; chemotaxis

Question 27

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

Answer 27

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.

Question 28

What are potential systemic side effects from corticosteroid use?

Answer 28

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

Question 29

What are potential side effects from inhaled corticosteroids?

Answer 29

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

Question 30

Adrenal suppression is not seen in doses under what level?

Answer 30

under 800 micrograms

Question 31

What is the dosage/ route for Flunisolide (AeroSpan)

Answer 31

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

Question 32

What is the dosage/route for Fluticasone (Flovent)

Answer 32

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

Question 33

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

Answer 33

DPI: 90 or 180 ug per actuation or | 0.5 mg/2ml nebulized 2x daily

Question 34

What is the dosage for Fluticasone/Salmeterol (Advair)

Answer 34

DPI: 100/50; 250/50; 500/50 (ug) | fluticasone/salmeterol twice daily

Question 35

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

Answer 35

MDI 80/4.5; 160/4.5 twice daily

Question 36

T/F Steroids increase B2 adrenergic receptor transcription

Answer 36

true

Question 37

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

Answer 37

true

Question 38

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

Answer 38

true

Question 39

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

Answer 39

``` 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 ```

Question 40

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

Answer 40

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

Question 41

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

Answer 41

``` oral thrush (candidiasis) dysphonia (hoarseness) ```

Question 42

How can you reduce topical local side effects?

Answer 42

use minimal doses use reservoir rinse and spit after use

Question 43

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

Answer 43

the answer is C

Question 44

What are some of the benefits of daily corticosteroid use?

Answer 44

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

Question 45

Why should oral steroids be tapered down when discontinuing therapy?

Answer 45

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

Question 46

What are some symptoms of steroid withdrawal?

Answer 46

anorexia, nausea, vomiting, lethargy, headache, hypotension