Corticosteroids

Question 1

Do the disease modifying effects of glucocorticoids stop when treatment is stopped for RA?

Answer 1

no, they persist even after discontinuation of therapy

Question 2

Do other DMARD therapies have true disease-modifying effect found in glucocorticoids?

Answer 2

No

Question 3

When should glucocorticoids be given to maximize effects with circadian rhythms?

Answer 3

during the night, as endogenous cortisol levels begin to rise.

Question 4

What is the mechansim by which the majority of anti-inflammatory effects of glucocorticoids occur?

Answer 4

via cytosolic GC repetors (cGCRs), which when activated upregulate and downregulate protein synthesis, negatively interfere with NFkB, AP-1 and NF-AT, reduce TNFa, IL1 and IL6, and reduce RANKL

Question 5

What is a non-genomic mechanism of GC effect?

Answer 5

rapid action on Src and intercalation into plasma and mitochondrial membranes

Question 6

What should be given with GCs to prevent osteoporosis?

Answer 6

Bisphosphonate drugs. They do a much better job than Ca and VitD supplements

Question 7

What is a risk of using NSAIDS with GCs?

Answer 7

PUD

Question 8

What should be given with GCs to reduce risk of PUD?

Answer 8

proton pump inhibitors (PPI) or PG analogs like misoprostol. Cox-2 inhibitors also reduce risk (celecoxib)

Question 9

How do GCs increase cardiovascular event risk?

Answer 9

GCs adversely impact lipid profiles, blood glucose, and insulin levels