Corticosteroids Flashcards
How do corticosteroids work?
Increase the gene expression of lipocortin, supresses phospholipase A2 that frees arachdonic acid
How are leukotrines, prostacyclin, prostaglandin, thromboxane made?
Membrane phospholipids break down with phospholipidase A2 to make arachidonic acid
Two paths come after
Lipoxygenase to create leukotrienes
COXI COX2 create prostacylin, prostaglandins, thromboxane
Do ICS directly relax bronchial smooth muscle?
Reduces bronchial reactivity, do not directly relax bronchial smooth muscle
What happens with NSAID/ASA induced asthma??
Bronchospasm- because NSAIDS block the COXI COX2 enzymes- shifting lipoxygenase to make leukotrienes.
10% of asthmatic patients
T/F; Intranasal steroids are directly applied to lungs leading to no systemic circulation?
F, only 10-20% are deposited to the lung
80-90% is swallowd, to the GI tract, to liver, systemic circulation
What are good intranasal steroids of children and why?
Budesonide and fluticasone- they have high first-pass effect
What are minor ADRs of inhaled corticosteroids?
Oropharyngeal candidiasis
Dry mouth
Cavities
Gingivitis
Dysphonia
What is a type of inhaled corticosteroid can be used to prevent oropharyngeal candidiasis?
Ciclesonide- activated in lung
What options can lower the chances of getting oropharyngeal candidiasis from inhaled corticosteroids?
Rinse and spit out water, spacer, nebulizer with mouth piece, ciclesonide, or pharmacological management anti fungal agent
What are major adverse effects of long term corticosteroids? (EXTENSIVE)
-Prevents accumulation of neutrophils and monocytes at sites of inflammation which increases infection risk, slow healing.
-Insomnia, behavioral changes, psychosis, depression, peptic ulcer.
- Increase appetite, increased weight, fluid retention, hypertension, hyperglycemia, moon face with fat deposition, fat redistribute (extremities to trunk)
-Osteoporosis (suppresses calcium absorption), ocular effects (glaucoma, cataracts) especially with high doses or oral route
-Myopathy and muscle wasting
What is a HUGE adverse effect from corticosteroids?
Adrenal function suppression, especially with high doses or oral administration
What happens to adrenal release when pts use corticosteroids?
Adrenals lower the release of cortisol in response to stressful situations since it knows it doesn’t have to work as hard
What do you need to do for patients if they’re taking steroids and are going to surgery, or have an acute infection, trauma?
Increase dose by 2-3x the normal dose.
Compensate for decrease adrenal release of cortisol. How to lower dose over several days or alternate day regimen to previous maintenance level.
What happens if you stop using corticosteroids cold turkey?
The adrenal glands can’t compensate fast enough, causing adrenal insufficiency
Does a single large dose cause adrenal crisis?
No.
