Corticosteroids Flashcards
What are the major hormones produced by the adrenal gland?
Mineralocorticoid (aldosterone), glucocorticoids (cortisol), and sex hormones (testosterone)
What are the two major parts of the adrenal gland?
Medula (inner portion) and Cortex (outer portion)
Where in the adrenal glands are its three major homones produced?
They are produced in the adrenal cortex. The cortex can be divided into 3 zonas.
Zona glomerulosa (mineralocorticoid)
Zona fascisculata (glucocorticoids)
Zona reticularis (sex hormones)
What are the functions of cortisol in the body?
- Mediate stress response (prepare body for stress via increased blood sugar, downregulate parasympathetic)
- Help regulate metabolism
- Help regulate inflammatory response and immune system
What is the HPA axis?
This system regulates production and secretion of cortisol.
Negative feedback loop
Hypothalamus–>Pituitary gland–>Adrenal gland
What are the most notable actions of glucocorticoids?
Supress inflammatory and immunological responses
What is the anti-inflammatory mechanism of action for corticosteroids?
- Altering cytokine release
- Blocking increased capillary permeability
- Lower vasoactive substances
- Inhibiting leukocyte and macrophage migration/adhesion
- Interfering with phagocytosis
What is the immunosuppressive mechanism of action for corticosteroids?
- Altering cell function of specific genes
- Affecting WBC function
- Inhibiting T-cell activation
- Inhibiting IL’s, cytokines, gamma-interferon, and TNF-alpha
What are some minor corticosteroid actions?
- Anti-mitotic activity
- Anti-tumour effects
- Anti-emetic effects
What is the most common way to sort corticosteroids into two categories?
Local vs. systemic agents
Why do patients prefer local agents over systemic corticosteroids?
Fewer side effects
What are the uses of Ophthalmic/Otic corticosteroids?
Used for: redness, itching, swelling, and pain
Commonly in combo with antibiotics
Available as drops, ointments, emulsions, intravitreal implants
What are some issues with Ophthalmic/Otic drops?
Incorrect delivery technique
45% of patients failed to get drops into the eyes
What are the uses of nasal inhaled corticosteroids?
Used for: Rhinitis, polyps, sinusitis
Issues with instillation technique
What are the uses of metered-dose corticosteroid inhalers?
Used for: mainstay for asthma
Very portable, but some patients may have incorrect inhalation technique
What is an advantage of inhaled dry powder corticosteoids vs. metered dose inhalers?
They list the number of remaining doses
Patient has to guess if they still have doses on a metered dose inhaler
What is the benefit of nebulizers as a delivery device?
Young children benefit from the mask fitting that can allow the administrator to release the drug into that closed space, allowing the child to breathe in the steroid easily
What are the goalpost corticosteroid products (based on potency)?
- Hydrocortisone (potency 7)
- Betamethasone valerate (potency 3)
- Betamethasone dipropionate (potency 2)
- Clobetasol propionate (potency 1)
What factors impact the efficacy of topical corticosteroids?
- Skin moisture
- Potency
- Formulation
- Application technique
- SIte (ex. hands vs. face)
- Skin condition
What are some corticosteroid rectal dosage forms
- Enemas
- Rectal Ointments
- Suppositories
- Rectal Foams
Used for: colitis, Crohn’s disease, hemmorhoids
What the types of injectable corticosteroids?
- Intravenous
- Intramuscular
- Intralesional
- Intra-articular
What are the advantages of intravenous corticosteroids?
Faster onset of effect
Useful when high doses are required
What are the usual sites of intra-articular corticosteroids?
hip, knee, ankle, shoulder, elbow, wrist
Do not inject more than 3-4 times per year
What are some qualities of oral corticosteroids?
They exhibit rapid and complete absorption from the gut
Oral doses are equivalent to IV due to quick absorption