Corticosteroids

Question 1

List disadvantages of hydrocortisone

Answer 1

1. Mineralocorticoid activity
2. Short duration (inc in liver insufficiency
3. Poorly absorbed through normal skin (but absorbed through inflammed skin & mucus membranes

Question 2

List advantages of synthetic cortisol preparations over cortisol

Answer 2

1. Mineralocorticoid activity is less with prednisolone & absent with dexamethazome
2. Longer duration of action
3. More absorption through skin

Question 3

Which cortisol preparation is preferred in pregnancy & why?

Answer 3

Prednisone
Minimal effect on fetus as it is progpdrug not activated by liver fetus & any prednisolone formed by mother is metabolised by placental enzymes.

Question 4

……..is used for replacement therapy in hypoadrenal states

Answer 4

Fluodrocortisone

Question 5

Advantages of beclomethazone in asthma

Answer 5

1. Radily penetrate the airway
2. Very short half lives after entering blood (if swallowed), due to extensive 1st pass metabolism so systemic side effects & toxicity are greatly reduced.

Question 6

List contraindications of glucocorticoids

Answer 6

1. Diabetes
2. HTN, HF
3. Severe infections, e.g. TB
4. Peptic ulcer
5. Psychosis & depression
6. Osteoporosis

Question 7

Mention corticosteroid effect on physical appearnce

Answer 7

Muscle wasting: thin arms & legs
Inc abdominal fat
Buffalo hump - obesity

Question 8

Mention dietary precautions of corticosteroid administration

Answer 8

Diet high in K+, Ca++, protiens, poor in Na+

Question 9

List precautions to avoid adrenal suppression

Answer 9

1. Small does (inc in stress) & alternate day schedules
2. Carry card “I am on steroid”
3. Gradual withdrawal

Question 10

Mention effect of corticosteroids on eye

Answer 10

Glaucoma & cataract

Question 11

Recovery from adrenal suppression requires…..

Answer 11

2-18 months

Question 12

Treatment of acute adrenal insufficiency

Answer 12

1. Saline & glucose (5%), maintain fluid, electrolyte balance & sugar level
2. IV hydrocortisone hemisuccinate
3. Fluodrocortisone is started when total cortisol dose is dec to 50mh/dl
4. Treat precipitating factors e.g. abs for infection

Question 13

Treatment of chronic adrenal insufficiency

Answer 13

Oral hydrocortisone inc dose with stress & surgery
Oral fluodrocortisone maintain Na+ balance & BP

Question 14

List therapeutic uses of corticosteroids in relief of inflammatory symptoms

Answer 14

1. Rheumatoid arthritis
2. Inflammatory skin conditions
3. Bronchial asthma
4. Inflammatory bowel disease
5. Cerebral edema (dec VD & exudation)

Question 15

………are used in premature delivery

Answer 15

Betamethasone
Dexamethasone

Question 16

Describe role of corticosteroids in malignancies

Answer 16

Dec lymphocytes in leukemia, lymphomas, inc appetite, inc Hb, RBCs, & platelets in patients on cytotoxic drugs

Question 17

Mention inhibitirs of adrenal steroids

Answer 17

Ketoconazole (used in cushing)
Spironolactone (aldosterone antagonist)