Corticosteroids Flashcards
The role of the adrenal glands is to…
Products??
Secrete mineralocorticoids, glucocorticoids, and sex hormones
Ex: Aldosterone (fluid control), cortisol, androgens (bone density, sexual desire, body maturation)
The primary functions of cortisol is to help regulate the following…
Mediate stress response
Regulate metabolism, inflammatory response, and immune system
Cortisol is released in response to ____
Stress
When stress resolves, cortisol also helps to…
Restore hormone levels
The short-term stress response involves…
Think of the different body systems
Increased HR, BP (SNS); changes in blood flow patterns
Increased BG (glycogen to glucose in liver)
Dilation of bronchioles
Increased metabolic rate
The long-term stress response involves…
Actions of mineralcorticoids and glucocorticoids long term lead to…
Mineralocorticoids - retention of sodium and water, increased BP and volume (RAAS)
Glucocorticoids - proteins + fats converted to glucose, increased BG, suppress immune system
Production and secretion of adrenal gland products is regulated via…
Hypothalamus-pituitary-adrenal (HPA) Axis
Connection between the brain and the adrenals
The hormone sequence that activates the adrenal glands is as follows:
Hypothalamus produces CRH, which makes pituitary secrete ACTH; which stimulates adrenals to release products.
The HPA-axis can regulate itself because cortisol works by…
Negative…
Negative feedback loop to prevent production of CRH and ACTH, stopping further production of cortisol + other adrenal products
Inflammation is a process where WBC’s and other mediators…
Protect against foreign substances
Long-term inflammation eventually becomes…
Unproductive to the body
Ex: Edema impeding blood flow
The inflammatory response often begins with stimuli, which triggers two factors…
Antigen-antibody response
Release of inflammatory mediators
Inflammatory mediators are directly correlated with…
guiding the immune cells to…
Cell mobilization to the tissue, often involving increasing capillary permeability
Common physical outcomes of inflammation involve…
Signs of injury
Edema
Erythema
Pruritis
Corticosteroids exert anti-inflammatory actions via
Impeding steps of the inflammatory process
Altering cytokine release
Blocking capillary permeability and less vasoactive substance release
Inhibiting leukocyte + macrophage migration/adhesion, and interfering with phagocytosis
Corticosteroids also have immunosuppressive qualities, which include…
Stopping immune response from even starting
Altering function of WBC’s, as well as cell function
Inhibiting T-cell activation, as well as interleukins, cytokines, and TNF-alpha synthesis
Corticosteroids have anti-mitotic activity, which means they can…
Inhibit DNA synthesis + epidermal cell turnover
Corticosteroids have shown anti-tumour effects, which may be related to the following…
Immune system? Tumour cell nourishment?
Inhibition of glucose transport, or induction of cell death in immature lymphocytes
Corticosteroids have anti-emetic effects, which may be due to…
Blockade of cerebral innervation of the emetic center
Corticosteroids are available as local dosage forms such as…
Otic, opthalmic, inhaled, topical
Corticosteroids are available as systemic agents, such as…
Injectables
Oral
Local agents may be more beneficial than systemic agents because…
Less adverse effects
Opthalmic/Otic corticosteroid formulations are often used for…
Redness, itching, swelling, and pain
A common issue with opthalmic/otic drops is…
Correct delivery technique (ex: administration of eyedrops)
Intranasal corticosteroids are often used for…
Rhinitis, polyps, and sinusitis
Inhaled corticosteroids are standard of care for…
Asthma therapy
Different dosage forms for topical corticosteroids include…
Lotions, creams, gels, and ointments
Rank the topical dosage forms from most occlusive to least occlusive.
Ointment, gel, cream, lotion
How is topical steroid potency arranged?
Scale from 1 to 7; 1 is ultra potent and 7 is mild.
Effectiveness of topical steroids is based on a multitude of factors, such as…
Skin moisture, skin condition
Steroid potency, skin condition, and application technique
Site of administration
Other dosage forms that a topical steroid could come in include…
Butt
Enemas, rectal ointments, rectal foams, and suppositories
Often used for inflammation, itching, and discomfort
Corticosteroids are injected IV when…
Circumstance
A faster onset, or high doses are required
IM corticosteroids onset of action is…
Delayed, and provides depot effects; pain relief varies
Depot = sustained action (but varies in people)
An uncommon way to inject corticosteroids is…
Ick
Intralesional
Intra-articular injections differ from IM injections since they have…
PK
A quicker onset and shorter duration
Suppress endogenous cortisol levels within 24-48 hours
Usual sites for intra-articular injections include…
Hip, knee, ankle, shoulder, elbow, and wrist
How frequently can a joint be injected?
3-4 times per year
Oral corticosteroids PK shows that…
They exhibit rapid + complete absorption from the gut
Oral doses are equivalent to IV doses
Oral corticosteroids are available as…
Dosage form?
Tablets or oral solutions
Budesonide unique - tablet/capsules
Our bodies produce ____ cortisol per day
10-20mg
Physiological dosing of corticosteroids are used to…
Replace deficiencies
Amount of cortisol excreted by adrenal cortex per day; ~5mg prednisone
Pharmacologic dosing of corticosteroids are used to…
Treat disease states, and provide supportive therapy
Low dose/maintenance dosing for pharmacologic treatment using oral CS is…
PREDNISONE equivalent
5-15mg/day
Moderate dosing for pharmacologic treatment using oral CS is…
PREDNISONE equivalent, starting to base off weight
0.5mg/kg/day
High dosing for pharmacologic treatment using oral CS is…
PREDNISONE equivalent, weight based
1-3 mg/kg/day
A massive dose for pharmacologic treatment using oral CS is…
PREDNISONE equivalent, weight based
15-30 mg/kg/day
Rank the corticosteroids based on their strength, from lowest to greatest
Care health professions put money (into) T D Bank
Cortisone, hydrocortisone, prednisone, prednisolone, methylprednisolone, triamcinolone, dexamethasone, betamethasone
Anti-inflammatory potency
Corticosteroids may also have mineralocorticoid potency (sodium retention); which are…
Na-retaining potency correlates with…
The weaker corticosteroids - cortisone + hydrocortisone
Prednisone, prednisolone, methylprednisolone have some, but are less.
These corticosteroids have a short duration of action…
Cortisone, hydrocortisone
8-12 hour half-life
These corticosteroids have an intermediate duration of action…
Prednisone, prednisolone, methylprednisolone, triamcinolone
12-36 hour half-life
Potency correlates with half-life, because…
Higher potency = Longer half-life (duration of action)
These corticosteroids have a long duration of action…
Dexamethasone, betamethasone
36-72 hour half-life
Equivalent dosing for cortisone is…
25mg
Equivalent dosing for hydrocortisone is…
20mg
Equivalent dosing for prednisone is…
5mg
Equivalent dosing for prednisolone is…
5mg
Equivalent dosing for methylprednisolone is…
4mg
Equivalent dosing for triamcinolone is…
4mg
Equivalent dosing for dexamethasone is…
0.75mg
Equivalent dosing for betamethasone is…
0.75mg
Equivalent dosing measurements can be used to…
Safely manage dosing adjustments between corticosteroids
