Corticosteroids

Question 1

how do steroids have such diverse actions and different actions in different tissues

Answer 1

because in each tissue steroids cause a different reaction due to the gene expression

Question 2

adverse effects of steroids

Answer 2

HPA axis suppression
growth retardation (slows growth but does not inhibit total growth)
increase risk of bleeding (due to blocking COX1 and COX2)
edema and weight gain (due to salt retention)
increase infection risk
leukocytosis
osteopenia
poor wound healing
cataracts
glacoma
mood changes
hyperglycemia
inhaled: thrush and dysphonia

Question 3

what is HPA axis suppression

Answer 3

hypothalamus-pituitary-adrenal: this system regulates how much steroid is produced
this system sees all steroids the same so when taking steroids the axis ultimately tells the adrenal to not make steroid which causes adrenal atrophy

Question 4

clinical consequences of HPA axis suppression

Answer 4

need to taper the drug to avoid adrenal insufficiency which can affect hemodynamics, blood glucose and blood volume. when tapering the drug this gives the adrenals time to wake up

adrenals are responsible for increasing steroid levels when stressed so when a pt is on steroids and is undergoing severe stress we need to give more steroid or we could risk adrenal insufficiency, this is called stress dose of steroids

Question 5

non infectious leukocytosis

Answer 5

this is when someone is taking steroids this pushes the resting WBCs that were on the lining of the vessel off into circulation which can cause an apperence of increase WBC so we need to look for other signs of infection which is called bands, bands are increase immature WBC, bands=infection and no bands= no infection

Question 6

what does mineralocorticoid potency mean

Answer 6

ability to retain salt and cause edema and weight gain, cortisol is a 2 so anyone who is having replacement therapy should find a drug similar to a 2, which is hydrocortisone. prednisone is a 1 so it has mild ability

Question 7

drugs in this list

Answer 7

hydrocortisone: 2
prednisone: 1
methlyprednisolone
prednisolone
clobestasol

Question 8

when is having a steroid high in causing salt retention appropriate and not appropriate

Answer 8

long term replacement therapy: appropriatre
short term for poison ivy: not appropriate

Question 9

MDI drugs

Answer 9

fluticasone
triamcinolone

Question 10

combination

Answer 10

fluticasone and salmeterol
budesonide and formoterol
fluticasone and vilanterol