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Pharm Exam III > Corticosteroids > Flashcards

Corticosteroids Flashcards

0
Q

Hydrocortisone indications

A

Replacement therapy for adrenal insufficiency

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1
Q

Hydrocortisone

A
  • aka cortisol

- Exhibits both mineralcorticoid and glucocorticoid properties

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2
Q

Cortisone (Cortone) indications

A

Replacement therapy for adrenal insufficiency

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3
Q

Cortisone (cortone)

A
  • Significant mineralcorticoid as well as glucocorticoid properties
  • Cortisone must first be converted to hydrocortisone in the liver in order to be active**
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4
Q

Prednisone (Meticorten) and prednisolone (delta-cortef)

A
  • More glucocorticoid effects than mineralcorticoid]
  • Prednisone must first be converted to predinsolone in the liver in order to be active**
  • Prednisone is the most commonly prescribed oral glucocorticoid
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5
Q

Triamcinolone (Kenalog), methylprednisolone (Medrol)

A
  • Virtually no mineralcorticoid activity
  • High glucocorticoid activity
  • most newer glucocorticoid drugs are like these drugs**
  • Differences in duration and potency
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6
Q

Preparations-oral

A

Long term therapy

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7
Q

Preparations-injections

A

Emergencies or depot administration

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8
Q

Preparation-inhalation or intranasal

A

asthma and rhinitis

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9
Q

Preparations-Topical

A
  • Fairly insoluble to prevent absorption
  • More potent topicals–>thick skin only
  • Skin damage or thin skin: Increases systemic absorption
  • Repeated application–>depot effect
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10
Q

Adrenocorticosteroids-therapeutic uses

A
  • Replacement in chronic adrenal insufficency (Addisons, etc.)
  • Treated w/glucocorticoid alone or glucocorticoid + mineralcorticoid**
  • Use increased amounts w/stress or infection
  • Acute insufficency can be life threatening**
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11
Q

Adrenocorticosteroids-rheumatoid arthritis

A
  • Reduce inflammation
  • Reduce pain
  • Restore function
  • Not curative!!
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12
Q

Adrenocorticosteroids-other conditions

A
  • Intranasal for rhinitis**

- SLE, allergic rxns, shock, organ transplants, etc.

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13
Q

Adrenocorticosteroids-Asthma

A
  • Inhaled-first step in asthma treatment (DOC)
  • In conjunction with beta 2 agonist (increased sensitivity)
  • Oral-used in patients who are not controlled by inhaled steroids
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14
Q

Adrenocorticosteroids important pts.

A
  • Chronic treatment may leave the HPA subnormal for months

- Short term therapy (1-2 wks) is not likely to cause serious problems**

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15
Q

Adrenocorticosteroids therapeutic guidelines

A
  • Only as long as necessary
  • Lowest effective dose** (start with a higher dose and lower the dose once the inflammation reduces)
  • Use LOCALLY whenever possible
  • Give on alternate days** (decreases suppression of the HPA axis)
16
Q

Corticosteroid therapy

A
  • Few significant side effects with acute therapy
  • Palliative effect not curative
  • many adverse effects with long term, high doses
17
Q

Adrenocorticosteroids adverse effects

A
  • infection, hyperglycemia, CNS, osteoporosis, Misc. effects
  • Iatrogenic Adrenal Insufficiency
  • > 1-2 weeks of high dose therapy–>HPA depression
  • Abrupt drug cessation–>acute adrenal insufficiency
  • Stress can cause adrenal crisis in chronic patients
18
Q

Infections

A

– May mask symptoms

– More susceptible to serious infections

19
Q

Hyperglycemia adverse effect

A

May unmask diabetes in some pts.

20
Q

CNS adverse effect

A

– Restlessness, insomnia, psychoses, ↑appetite

– Even with acute treatments**

21
Q

Therapies to reduce HPA axis depression

A

Alternate days or monitoring dosing

22
Q

Osteoporosis-adverse effect

A

-Most damaging and therapeutically limiting effect**
-30-50% of chronic patients –>fracture
-Vertebral and rib fractures most common
(treatment includes Vit D, calcium, bisphosphonates)

23
Q

Contraindications in corticosteroids

A
  • NONE IN ADRENAL INSUFFICIENCY
  • Systemic bacterial or viral infection
  • Poorly controlled diabetes
  • Osteoporosis
  • Heart disease or hypertension with congestive heart failure
  • Immunosuppressed patients
  • Childhood, pregnancy
24
Q

Miscellaneous (cushingoid) side effects

A

– Acne, striae
– Truncal obesity
– Buffalo hump**
– Moon face**

(Dysmenorrhea, Skin atrophy and thinning)

26
Q

Things to monitor in corticosteroid patients (8)

A
  • Hyperglycemia & glycosuria
  • Na+ retention w/ edema or hypertension
  • Hypokalemia
  • Peptic ulcer
  • Osteoporosis
  • Infections
  • Growth and development in children
  • Pregnancy – glucocorticoids are teratogenic
26
Q

Ketoconazole (Nizoral®)

A

Antifungal that inhibits steroid synthesis (very high doses)
• Non-selective
• Preoperative suppression

27
Q

Aminoglutethimide (Cytadren)

A

– Blocks adrenal and gonadal steroid synthesis**
– Corticosteroids must be given concomitantly to suppress ACTH
– Not on market anymore

29
Q

Mifepristone (RU 486®)

A
  • Antagonist of glucocorticoid and progesterone receptors**

* For inoperable Cushings patients

30
Q

Spironolactone (Aldactone®)

A
  • Mineralocorticoid (and some androgen) receptor antagonist
  • Potassium-sparing diuretic
  • For hyperaldosteronism and hirsutism**

Pharm Exam III (11 decks)

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