Chapter 11 - Corticosteroids Flashcards
When would you use an intranasal aerosol corticosteroid?
Management of seasonal and perennial allergies and nonallergic rhinitis
What is the name of the group of chemicals released by the adrenal cortex?
Adrenal cortical hormones
What chemical does the outer zone of the adrenal cortex release?
Corticosteroids
What chemical does the inner zone of the adrenal cortex release?
Epinephrine
What are the three types of corticosteroid hormones?
Glucocorticoids (cortisol)
Mineralorticoids (aldosterone)
sex hormones (androgens & estrogen)
What does aldosterone do?
Regulates body water by increasing amount of sodium reabsorption in kidneys.
What is another term for analogs of cortisol used in pulmonary disease?
Hydrocortisone
What is the pathway for release and control of corticosteroids?
Hypothalamic-pituitary – adrenal axis
What hormone in the body stimulates the adrenal cortex to secrete glucocorticoids?
Adenocorticotropic hormone
ACTH
What are the main functions of glucocorticoids?
Metabolism of fats and carbohydrates
Glucose for body energy
lipolysis, redistribution of fat stores
breakdown of tissue protein
What is steroid diabetes?
Excessive amounts of glucose in plasma due to overuse of steroid therapy
What is HPA suppression?
Significant side effect of using corticosteroids
Adrenal suppression of endogenous glucocorticoids
What does the body not do, with regards to endogenous and exogenous corticosteroids?
It cannot distinguish between exogenous and endogenous glucorticoids
What is HPA suppression
When the body takes in too much exogenous cortisol that it doesn’t feel the need to create its own.
What is a good way to minimize HPA suppression?
By using aerosolized glucocorticoids and localizing the treatment to the lungs
What do you need to do when a patient is on oral corticosteroids and HPA suppression occurs?
We need to wean them off in order to let the body create its own again.
What are the clinical indications for use orally inhaled corticosteroids?
- Maintenance, controlled therapy of chronic asthma, (identified as needing step 2 asthma care)
- can be used with systemic corticosteroids to reduce systemic dose or elimination for asthma control
When are endogenous coritsol levels the highest?
In the morning
What stops the production of endogenous glucocorticoids and ACTH?
High levels of cortisol in blood plasma because of the feedback mechanism.
What is alternate days steroid therapy?
Giving steroid drugs that alternate days in the morning to avoid HPA system suppression
What are the four major categories of inflammation activity?
Increased vascular permeability
Leukocytic infiltration
Phagocytosis
Mediator cascade
What are the two most common inflammatory diseases of the airway?
Chronic bronchitis
Asthma
What are the two major effector cells of the. Asthmatic inflammatory response?
Mast cells
Eocinophils
What is shown to cause early phase asthmatic response in airways?
What does symptom does it cause?
Immunoglobulin E
Bronchospasm
What happens during the late phase inflammatory response?
Submucosal edema
Mucus
Hyperreactivity
When does the late phase inflammatory response occur?
6 - 8 hours after challenge
What is a product of persistent shedding of epithelial cells in the respiratory system during inflammatory response?
Airway remodeling which can cause thickening in the basement membrane and increase epithelial damage enhancing inflammatory response in the future.
How can you classify aerosolized glucocorticoids as a drug?
And how was it absorbed by cells?
It is a topically active drug
It is absorbed by lipid diffusion because it is lipid soluble
What are the 3 general modes of action for glucocorticoids?
- Upregulation transcription of anti-inflammatory genes
- suppression of factors that activate transcription of inflammatory genes
- up regulate the expression of inhibitors of the inflammatory response
What is the effect of glucocorticoids on white cell counts?
It increases over all white cell count like neutrophils
A person with allergic asthma would have what kind of results on a white cell differential?
Higher than normal eosinophil count
What is a benefit of using glucocorticoids for patients prescribed with beta adrenergic agents?
It can restore responsiveness to beta-adrenergic agents
How do glucocorticoid drugs enhance receptor stimulation?
By increasing number, availability, and affinity of beta receptor cells.
What is a good reason why you would take a corticosteroid and beta-adrenergic combo?
Because corticosteroids can prolong endogenous circulation of catecholamines prolonging the interaction of beta agonist.
What are some hazards associated with systemic administration steroids?
F I M H H H
Fluid retention Immunosuppression Muscle wasting HPA suppression High glucose levels Hypertension
What are 2 side effects of the local topical corticosteroid administration?
Oral thrush and dysphonia
What is something you should tell the patient after taking an oral topical dose of corticosteroid?
Rinse their mouth
How would you describe asthma as a disease?
It’s a disease of inflammation leading to bronchial hyperresponsiveness
What is the use of inhaled corticosteroids for treatment of asthma?
It is the first line of treatment
Most effective long-term therapy for persistent asthma
Can you use inhaled corticosteroids for acute severe asthma?
No, studies have shown that it is not useful due to no bronchodilator effect
But is should be reconsidered
What is the use of corticosteroids for COPD?
It can relieve symptoms but it has a little effect on FEV1
What cell is predominantly involved in inflammation with COPD patients?
Neutrophils
