Corticosteroids

Question 1

List effects of corticosteroids in inflammatory cells. (eosinophil, T-cells, Mast cell, Macrophages, neutrophils and dendritic cell)

Answer 1

Decrease numbers of eosinophil and mast cell due to decrease in cytokines by T lymphocyte
Decrease number of dendritic cell
decrease cytokines by macrophages

BUT number of neutrophils increases

Question 2

List effects of corticosteroids in airway smooth muscle.

Answer 2

Corticosteroids have numerous actions including increased expression of beta-2 adrenoceptors and reduction of expression of cytokines.

Question 3

List effects of corticosteroids in endothelial cell and mucus gland.

Answer 3

decrease leak (permeability) and decrease mucus secretion

Question 4

What is important to note when ordering corticosteroid?

Answer 4

Cannot stop dosing suddenly due to interference with body natural negative feedback system

Question 5

(recap) What is the function of mineralocorticoid?

Answer 5

Aldosterone promotes Na+ reabsorption at Distal renal tubules coupled with K+ and H+ excretion

Question 6

What is fludrocortisone? What is it used to treat?

Answer 6

Fludrocortisone is a mineralocorticoid synthetic analogue. Fludrocortisone is used to treat conditions in which the body does not produce enough of its own steroids, e.g., Addison’s disease, and salt-losing adrenogenital syndrome

Question 7

List at least FIVE examples of pro-inflammatory gene targets decreased by corticosteroids.

Answer 7

Reduced expression of pro-inflammatory genes:
Cytokines e.g., TNF‐α, IL‐2,IFNγ
Chemokines e.g., RANTES
Inflammatory enzymes e.g., Cyclooxygenase‐2(COX‐2), 5‐Lipoxygenase (5‐LOX), Phospholipase A2 (PLA2)
Adhesion Molecules e.g., ICAM‐1, VCAM‐1
Receptors e.g., IL‐2R (αchain), T‐CellReceptor (βchain)

Question 8

List 2 examples of anti-inflammatory gene targets increased by corticosteroids.

Answer 8

β2‐adrenoceptor
IκB‐α (Inhibitor of NF‐κB,cytokines)

Question 9

Name a clinically used corticosteroid with equal glucocorticoid and mineralocorticoid effects

Answer 9

Hydrocortisone (cortisol)

Question 10

List at least THREE examples of corticosteroids with minimal or zero mineralocorticoid effect

Answer 10

Methylprednisolone, Triamcinolone, Betamethasone, Dexamethasone

Question 11

Name an example of a highly potent corticosteroids with a long duration of action (24 to 72 hours)

Answer 11

Betamethasone, Dexamethasone

Question 12

Name an example of a potent corticosteroid that is highly effective for topical application

Answer 12

Betamethasone

Question 13

Name an example of a corticosteroid with a short duration of action (8 to 12 hours)

Answer 13

Hydrocortisone (cortisol)

Question 14

List endocrine/metabolic/cardiovascular side effects of long-term treatment with corticosteroids

Answer 14

Endocrine‐Metabolic Effects: (similar to Cushing syndrome)
* Hyperglycaemia (and increased risk of diabetes mellitus type II)
* Moonface, ‘buffalo hump’ & truncal obesity
* Muscle wasting
* Growth retardation (pediatric patients)
* Na/fluid retention ( increase Na+ reabsorption), oedema, hypertension, chronic heart failure

Question 15

List musculoskeletal system side effects of long-term treatment with corticosteroids

Answer 15

Musculoskeletal System
* Osteoporosis (trabecular bone)
* Aseptic necrosis of femoral head
* Myopathy (esp. dexamethasone/triamcinolone)

Question 16

List immune system side effects of long-term treatment with corticosteroids

Answer 16

Immunosuppression leading to opportunistic infections.

Question 17

List central nervous system side effects of long-term treatment with corticosteroids

Answer 17

Euphoria, depression, psychosis

Question 18

List side effects in the eye of long-term treatment with corticosteroids

Answer 18

Posterior Subcapsular Lens Cataract and Glaucoma

Question 19

What is the standard choice principle for corticosteroid therapy

Answer 19

1. Shorter‐acting steroids with little salt‐retaining activity (e.g., prednisolone)
2. Lowest dose possible
3. alternative day therapy or pulse therapy
4. In prolonged therapy, check: chest X‐Ray, tuberculosis, diabetes mellitus, peptic ulcer disease, osteoporosis, and mental disorder

Question 20

Name 2 clinically used corticosteroid with both glucocorticoid and mineralocorticoid effects

Answer 20

Hydrocortisone and Prednisolone