Chapter 11 Corticosteroids Flashcards
Two RRT drugs sound alike- pulmicort and pulmozyme. Which is a corticosteroid?
pulmicort
What are the clinical indications for the use of inhaled corticosteroids?
Step 2 asthma
COPD (to increase responsiveness of beta agnonist receptors)
Where are endogenous corticosteroids produced?
in the adrenal cortex
How do corticosteroids work in the treatment of asthma?
mediates the body’s inflammatory response
Briefly describe the role of antigens in the inflammatory process
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.
What are the clinical symptoms associated with inflammatory response in the lung?
wheezing, shortness of breath, cough, tightness, hypoxemia
Which type of asthma is the most common (according to Denise’s powerpoint)
allergic asthma
What is the preferred method of treatment for allergic asthma?
immunotherapy (identifying and desensitizing to the specific triggering allergan)
T/F In non allergic asthma, there is no immune system response
true
Name 3 triggers for non-allergic asthma
cold air, exercise, stress, infection
What is involved in the early-phase inflammatory response?
local vasodilation; increased vascular permeability; redness, swelling
(further in asthma bronchial contraction as a result of mast cell degranulation)
When does late-phase inflammatory response occur?
6-8 hours after initial exposure
What happens during late state inflammatory response?
leukotrienes and prostaglandins are released leading to mucosal edema, increased mucus production, mucus plugging and hyperreactivity of the airways and increased vascular permeability
Treatment is aimed at stopping inflammatory progression at what stage?
the earlier the better- late stage inflammatory response is much more difficult to resolve
T/F Bronchodilators will help mediate the inflammatory response.
False. they reverse bronchospasm but don’t touch inflammation
What effect does cromyln sodium have on mast cells?
it prophylactically coats mast cells to prevent them from degranulating
What is the function of the hypothalamic pituitary adrenal axis?
It is the pathway for the release and control of corticosteroids
T/F The body distinguishes between endogenous and exogenous steroids.
False. The body CANNOT distinguish them
Administration of glucocorticoid drugs inhibits the body’s production of glucocorticoid drugs by inhibiting the ______ and ____ glands
hypothalamus and pituitary glands
What effect do corticosteroids have on blood sugar levels?
causes them to rise- can cause steroid induced diabetes
Production of the body’s own glucocorticoids follows a rhythmic cycle called what?
the diurnal steroid cycle (or circadian rhythm)
Cortisol levels in the body are highest when?
8 am
What dosing regimen will maintain the body’s endogenous production of glucocorticoids?
alternate-day steroid therapy- giving steroids early am every other day will sync with the body’s HPA system
What causes the redness in inflammatory reactions?
local dilation of blood vessels (it occurs in seconds)
What is involved in the body’s “triple response” to inflammation
redness, flare (reddish color several centimeters from the site occuring within 15 to 30 seconds) and wheal- local swelling that occurs in minutes
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 _____.
white blood cells; chemotaxis
List the components of patient education that should be undertaken when corticosteroid treatment has been prescribed
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.
What are potential systemic side effects from corticosteroid use?
renal insufficiency, acute asthma, HPA suppression, growth retardation, osteoporosis, high blood glucose, and tiny testicles :)
What are potential side effects from inhaled corticosteroids?
oropharyngeal fungal infections; hoarseness, vocal disturbances, cough, bronchoconstriction
Adrenal suppression is not seen in doses under what level?
under 800 micrograms
What is the dosage/ route for Flunisolide (AeroSpan)
MDI: 80 ug/per puff - 2 puffs twice daily
What is the dosage/route for Fluticasone (Flovent)
MDI: 44, 110, 220 ug puff (dosage varies) 2 x day
What is the dosage/route for Budesonide (Pulmicort)?
DPI: 90 or 180 ug per actuation or
0.5 mg/2ml nebulized 2x daily
What is the dosage for Fluticasone/Salmeterol (Advair)
DPI: 100/50; 250/50; 500/50 (ug)
fluticasone/salmeterol twice daily
What is the dosage/route for Budesonide/formoterol (Symicort)
MDI 80/4.5; 160/4.5 twice daily
T/F Steroids increase B2 adrenergic receptor transcription
true
T/F Inhaled corticosteroid therapy can provide partial protection against development of adrenergic tolerance
true
T/F Salmeterol has been shown to promote binding of the glucocorticoid receptor to the response element of the cell’s nuclear DNA
true
What are some hazards/complications associated with oral steroid burst therapy or IV steroids?
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
What are some systemic side effects that can be seen with aerosol administration?
adrenal insufficiency
allergic inflammation after cessation
suppression of HPA function
growth reduction in children
What are some topical/local side effects seen with aerosol administration?
oral thrush (candidiasis) dysphonia (hoarseness)
How can you reduce topical local side effects?
use minimal doses
use reservoir
rinse and spit after use
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
the answer is C
What are some of the benefits of daily corticosteroid use?
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
Why should oral steroids be tapered down when discontinuing therapy?
to give the body the chance to normalize and resume its production of endogenous corticosteroids
What are some symptoms of steroid withdrawal?
anorexia, nausea, vomiting, lethargy, headache, hypotension
