Corticoids Flashcards
What are corticoids? (2)
- steroid hormones
- synthesized in the adrenal cortex
Steroids are a derivative of…?
cholesterol
What steroid is produced in the ovaries? (2)
estrogen + progesterone
What steroid is produced in the testicles
androgens
What steroid is produced in the adrenal glands?
corticoids
What is the mineralocorticoid?
aldosterone
What is the function of aldosterone?
electrolyte metabolism (reabsportion) ex. water, sodium
What is the glucocorticoid hormone?
CORTISOL-HYDROCORTISONE
What is the function of cortisol? (4)
intermediate metabolism
- gluconeogenesis
- lipolysis
- proteolysis
What is the androgenic steroid?
androsterone
What is the function of androsterone?
virilizing effect (development of male characterisitics)
Describe the hypothalamic-pituitary-adrenal axis (3)
hypothalamus –> hypophysis –> adrenal glands
Describe the hypothalamic-pituitary-adrenal axis’s hormones (4)
CRH –> ACTH –> cortisol
Each hormone produced has a negative feedback on the one that produced it
What main matabolism effects do glucocoticoids have? (3)
- release of glucose
- decreased formation of proteins and fats
What are the other roles of glucocorticoids? (5)
- adaptation to stress
- anti-inflam.
- suppress immune system
- maintaining blood pressure
- bone density
Do steroids have more side effects than NSAIDs?
yes
Are steroids a more potent anti-inflam than NSAIDs?
yes
Are corticoid drugs natural or synthetic?
both
What is the advantage of synthetic corticoids? (3)
- metabolized slower in the liver
- therefore longer halflife
- more potent
Rank the glucocorticoids in order of highest potency (4)
- dexamethasone
- methylprednisolone
- prednisone
- cortisol
equivalent doses become ____ as the potency increases
smaller
equivalent doses for corticoids use which drug as a reference?
cortisol - activity = 1
What is the mechanism of action for corticoids?
-inhibition of phospholypase A2
glucocorticoids effects? (3)
- anti-inflam
- immunosupressive
- inhibition effect of lymphoid tissue
Glucocorticoid mechanism of action?
phospholipase A2 inhibition
route of administration for glucocorticoids? (6)
- oral
- IV
- IM
- topical
- inhaled
- SC
What is the immunosuppresive effect with glucocorticoids? (2)
- medium dose: prevent antigen-Ab binding stopping release of mediators and cell damage
- High dose: reduces synthesis of Ab and antigen-Ab binding
What is the inhibition effect of lymphoid tissues with glucocorticoids?
- decreased clonal expansion of T&B cells
- decreased action of T cells secreting cytokines
What are the 2 main glucocorticoid indications?
- endocrine replacement therapy
- non endocrine diseases
Why are glucocorticoids used for endocrine replacement therapy?
Addison’s disease
Why are glucocorticoids used for non-endocrine diseases? (6)
anti-inflam:
- rheumatic diseases
- idiopathic inflam diseases
- allergies(asthma, insect bites, urticaria)
Immunosuppressive
- autoimmune
- organ transplant (avoid rejection)
Neoplastic disease
- in combo with cytotoxic drugs to treat specific malignancies
ex. acute lymphocytic leukemia, hodkin’s
What types of allergies do glucocorticoids treat? (3)
- asthma
- insect bites
- urticaria
What are glucocorticoids immunosuppressive effects used for? (2)
- auto-imune diseases
- organ transplant (avoids rejection)
How are glucocorticoids used with neoplastic diseases? which? (3)
- in combo with cytotoxic drugs to treat specific malignancies
ex. acute lymphocytic leukemia, hodkin’s
What is the glucocorticoid route of administration for rheumatic diseases?
oral
What are the rheumatic diseases? (2)
- rheumatoid arthiritis
- ankylosing spondylitis
- other severe acute arthritis
How do we treat ankylosing spondylitis? (2)
- glucocorticoids are second choice
- use for shortest time and lowest possibile dose
What class of drugs treat bronchial asthma? whats the route of administration? (3)
- glucocorticoids
- inhaled
- IV
What drugs do we use for bronchial asthma? (4)
- Budesonide
- beclomethasone
- fluticasone
- IV glucocorticoids
When do we use IV glucocorticoids? (2)
- bronchial asthma (asthmatic crisis)
- digestive inflammatory diseases
When do we use IV glucocorticoids for bronchial asthma
during asthmatic crisis
-has side effects
What is the glucocorticoid route of administration for digestive inflam. diseases? (3)
- oral
- IV
- enema
What glucocorticoid is used for digestive inflam. diseases?
budesonide
What is the glucocorticoid route of administration for ocular inflammatory diseases?
topical
What ocular inflammatory diseases do we use glucocorticoids for? (3)
- allergic conjunctivitis
- scleritis
- uveitis
What is the glucocorticoid route of administration for skin diseases?(2)
- topical
- general
What skin diseases do we use glucocorticoids for? (3)
- eczema
- psoriasis
- pemphigus
What allergic diseases do we use glucocorticoids for? (2)
- anaphylaxis
- serum sickness
What autoimmune diseases do we use glucocorticoids for? (3)
- lupus erthematosus
- scleroderma
- vasculitis
Which glucocorticoids are used to treat leukemia and lymphoma? (2)
- prednisolone
- deamethasone
What are the routes of administration for glucocorticoids locally (4)
- topic
- inhaled
- subcutaneous
- intraarticular
What are the routes of administration for glucocorticoids systemic (4)
- ORALLY
- INTRAMUSCULAR (irregular bioavailability) -INTRAVENOUS
- RECTAL (enemas)
Which glucocorticoids are used orally?
- Prednisone - intermediate action
- Deflazacort - intermediate -Prednisolone
Steroids in dentistry used for: (8)
Stomatitis Lichen planus Desquamative gingivitis Cheilitis (inflammation of the lips) Traumatic ulcer Pulpitis Temporomandibular joint pain Systemic disease oral lesions
Steroid contraindications in dentistry?
herpetic sores
Topical steroid contraindications?
skin infections
Which topical steroid do we use first?
-hydrocortisone
Glucocorticoid contraindications? (3)
Gastroduodenal ulcer
Osteoporosis
Psychosis
What are the adverse reactions with glucocorticoids and mineralocorticoids? (5)
- cortisol, prednisone and prednisolone produce mineralocorticoid effect
- Na+ and water retention by the kidney.
Results in:
- weight gain
- oedema
- hypertension
What are the adverse reactions with glucocorticoids mentally? (5)
- Moderate euphoria, feeling of well-being
- Insomnia
- depression
- memory impairment
- Acute psychosis
What are the adverse reactions with glucocorticoids and eyes? (3)
- cataracts
- intraocular hypertension
- glaucoma (genetically predisposed)
What are the adverse reactions with glucocorticoids and hormonal changes? (3)
- inhibition of growth >6months in children
- women: menstrual disorders + amenorrhea
What are the adverse reactions with glucocorticoids and digestion? (2)
- alters gastric mucoa causing gastritis or peptic ulcer
- acute pancreatitis
What adverse effect happens with postmenopausal women and glucocorticoids?
loss of bone mass
What are the adverse reactions with glucocorticoids and bones? (2)
- loss of bone mass
- happens more in postmenopausal women
What are the adverse reactions with glucocorticoids and muscles? (2)
- loss of strength
- weakness/atrophy
What is the iatrogenic adverse reactions with glucocorticoids
cushings disease
What are the adverse reactions with glucocorticoids and adrenal cortex? (2)
- hyperglycemia: steroid diabetes
- hyperlipidemia
What are the adverse reactions with glucocorticoids and adrenal cortex? (2)
- atrophy
- supression/inhibition of hypothalamic-pituitary-adrenal axis
What are the irreversible side effects of glucocorticoids? (3)
- osteoporosis
- in children- inhibition of growth
- eye disorders - cataracts
Most adverse effects for glucocorticoids… (2)
disappear after months or years of stopping treatment.
*some are irreversible
Describe adverse reactions with glucocorticoids treatment duration (2)
- short treatments (<15 days): none
- long treatments (>2months): appear with doses above 5-10 mg prednisone/day
To maintain disease control, glucocorticoid treatment starts off….
high dose (ex. prednisone) and decreased slowly until lowest dose
