Corticosteroids

Question 1

Benefits of corticosteroids in treating RA

Answer 1

Disease modifying effect → prevention of erosions, persistence after discontinuation of drug

Question 2

Best time to administer glucocorticoids

Answer 2

At night, mimicking the endogenous rise in production

Question 3

Mechanism of glucocorticoids in bone

Answer 3

Bind to cGCR to make complex which can bind to GREs to increase txn of anti-inflammatory genes or to decrease txn of pro-inflammatory genes. Can also bind NFkB, NFAT, or AP-1 co-activators to prevent txn of inflammatory cytokines like TNF, IL-1, & IL-6 in macrophages.
Macrophages and TH17 release cytokines that stimulate synovial fibroblasts to produce RANKL & M-CSF to cause production & activity of osteoclasts

Question 4

Screening measures for low-dose corticosteroids

Answer 4

Osteoporosis, fasting blood glucose, glaucoma, ankle edema

Question 5

Concurrent use with NSAIDs increases risk of…

Answer 5

Peptic ulcer disease

Use a PPI or PG analog with NSAID or COX-2 selective inhibitor

Question 6

How do glucocorticoids increase CV risk

Answer 6

↑ blood lipids, alter blood glucose regulation, ↓ insulin production & ↑ resistance, ↑ obesity
But also ↓ endothelial dysfunction & permeability

Question 7

Short- to medium-acting glucocorticoids

Answer 7

Hydrocortisone, cortisone, prednisone

Can cause salt retention due to mineralocorticoid activity

Question 8

Intermediate-acting glucocorticoids

Answer 8

Triamcinolone

No mineralocorticoid activity

Question 9

Long-acting glucocorticoids

Answer 9

Betamethasone, dexamethasone - much more potent than hydrocortisone
(No mineralocorticoid activity)

Question 10

Monitoring parameters for NSAIDs

Answer 10

LFTs, serum Cr/BUN, stool guaiac, CBCs

Question 11

Monitoring parameters for aspirin

Answer 11

LFTs, serum Cr/BUN, serum salicylate conc., stool guaiac