Corticosteroids Flashcards
What are the 3 different steroid hormones
Glucocorticoids, mineralcorticoids, sex steroids
Glucocorticoids
essential during stress, down regulates immune ststerm activity
Mineralcorticoids
essential for liffe, regulate Na/K levels
Sex steroids
androgens, estrogens, progestogens
What are corticosteroids synthesized from?
cholesterol within the adrenal cortex
What are most steroidgenic rxns catalyzed by
enzymes in the cytochrome P450 family
What are the physiological actions of glucocorticoids
metabolic effects
what are the pharmocological effects of glucocorticoids
anti-inflammatory, immunosuppressive and anti anaphylaxis, anti-shock, hematologic
What are the adverse effects of glucocorrticoids
GI, CNS exciting effects
What are the carb metabolism effects of corticosteroids
inc gluconeogenesis, dec peripheral utilization of glucose, inc glycogen deposition in liver
what are the protein metabolism effects of corticosteroids
breakdown of protein, mobilization of amino acid from periphery, negative nitrogen balance
Effects of carb and protein metabolism results in
diabetes like state state resistant to insulin, increased urea production, wasting of muscle lympholysis, thinning of skin
Effects of fat metabolism
increased lipolysis, decreased lipogenesis, inc breakdown of TGA, redistribution of fat- moon face
effects on electrolyes and H2O
enhanced Na reabsorption from the distal tubules of the kidney, will lead to fluid retention, an association inc in urinary excretion of K and H+, edema and hypertension common
What is the effect on anti-anaphylaxis
inhibits histamine release by basophils/mast cell
Antishock effects
dec inflammatory factors release, inc body resistance to bacterial endotoxin, permissive role as a vasopressor (effects angotensin), inc myocardial contractibility
Hematologic effects
stimulates hematopoiesis in bone marrow, RBC inc, Hgb inc, PLT inc
What do steroids do to the GI
increase gastric acid, increase pepsin
What do steroids do to the CNS
euphoria, can cause seizures at high doses, insomnia but rare
Symptoms of addison’s disease
fatigue, orthostatic hypotension, wt loss, changes in mood, arthralgias, hyperpigmentation
Lab abnormalities of addison disease
hyponatremia, hyperkalemia, hypercalcemia, hypoglycemia, eosinophilia, lymphocytosis, metabolic acidosis
What is treatment for addisons
replace cortisol with hypdocortisone or prednisone, replace aldosterone with fludocortisone
What is a test for cushings
dexamethasone suppresion test
Treatment for cushings
taper and stop corticosteroids, remove tumore if needed, ketoconazole, mifepristone
Injectable steroids
betamethasone, dexamethosone, hydrocortisone, methylprednisolone, prednisolone, triamcinolone
Oral steroids
betamethasone, fludrocortisone, methylprednisolone, prednisolone, prednisone
Inhaled steroids
advair, symbicort, azmacort, asmanex twisthaler, flovent, aerobid, pulmicort, QVAR
What are uses of hydrocortisone
antiinflammatory, replacement, shock, status asmaticus, ulcerativve colitis, crohns, thyroid storm
Dosage of hydrocortisone
100 mg IV TID-QID, 20 mg PO daily, rapid but short acting
Predisone/Predisolone uses
allergy, asthma, COPD, autoimmune, inflammation, malignancy
What is DOC steroid for peds
prednisone
Dosage of prednison
Chronic- 5-20 mg PO daily, if acute must taper 60 mg TID down to 10 mg PO TID
Methylprednisolone uses
allergy, antiinflammatory, asthma, COPD, immunosuppressive, pulse therapy in non responsive RA, renal transplant
What is potency and selectivity of methylprednisolone
more potent, GC selective
Dosage of methylprednisolone
IV- 125 mg QID- aggressive; 60 mg TID middle; 40 mg BID low; can go up to 250 mg QID
Triamcinolone use
arthritis injection, dermatoses, hay fever, MS
What is potency and selectivity of triamcinolone
potent and GC selective
Dexamethosone uses
antiemetic, cerebral edema, cushings, dexamethasone suppression test, MS, inflammayion, allergy, physiological replacement, shock
Pearls of dexamthasone
very potent, highly selective GC, causes HPA suppression
Betamethasone uses
bursitis, dermatologic, MS, peritendinitis, tenosynovitis, RA OA
Betamehtasone PEARL
very potent selective GC
Fludrocortisone use
congenital adrenal hyperplasia, orthostatic hypotension, replacement for Addison’s
Pearl of fludrocortisone
potent MC, some GC, dont use for inflammation or immunosuppression
what renal diseases can steroids treat
nephrotic syndrome in children, renal disease ssecondary to SLE, renal sarcoidosis, glomerulonephritis
What other immunosuppressants are steroids combined with for organ transplant
cyclosporine, azathioprine
What infectious dissease can steroids treat
AIDs and pneumocystis carinii pneumonia, haemophilus influenza meningitis, tubercular meningitis, sepsis
Steroids are essential for what malignancy
ALL, hodgkin’s or other lymphoma, hormone responsive breast cancer, can provide symptomatic relief in other CA
Other uses of steroids
acute mountain sickness, aspiration pneu, pulmonary edema, cerebral edema, thyroid storm, idiopathic thrombocytopenic purpura
Short term admin ADRs
insomnia, inc appetite, wt gain, behavioral, peptic ulcer
Steroid withdrawal
weakness, fatigue anorexia, arthralgias, wt loss, NVD, hypoglycemia, fainting, hypotension, shock, death
Warnings of steroids
CVD, DM, peptic ulcer, hepatic impairment, MI, osteoporosis, seizure disorder, glaucoma, infection, HTN
Contraindication of steroids
systemic fungal infection
Long term steroid ADR
CVD, metabolc, endocrine, skeletal, GI, hypokalemia, neuropsychiatric, immune function
