Corticosteroids Flashcards
Mineralocorticoids are regulated by
- angiotensin II
- K+
Glucocorticoids-cortisol is regulated by
- ACTH stimulates release
effect of Glucocorticoids on carbs, protein, and fat
- increase circulating levels of glucose, free fatty acids and amino acids
- antagonizes insulin
- redistribution of body fat (extremities -> central)
effect of Glucocorticoids on cardiovascular function
- increase vascular responsiveness to sympathetic stimulation
- inhibits catecholatmine reuptake
- some Na+ and H2O retention
- increase CO
effect of Glucocorticoids on endocrine
- CRH
- GH
- TSH
- LH
- epi
- negative feedback on CRH -> Decrease ACTH
- decreases
- GH
- TSH
- LH -> inhibits reproduction
- increase Epinephrine production from adrenal medulla
glucocorticoid effect on vitamin D and parathyroid
- vit D -> decreased Ca2+ deposition into bone
- increases parathyroid hormone -> increase Ca2+ loss from bone
glucocorticoid effect on immune system
-
immunosuppressive
- decrease WBC #
-
blocks all steps in inflammation
- blocks heat, erythema, swelling, tenderness
- decreases PLA2, COX2, cytokines and IgE responses
- suppression of wound healing
glucocorticoid effect on CNS
- mood elevation
- insomnia
- anxiety
- depression
- psychosis
glucocorticoid effect on GI
associated with peptid ulcer development
What is Cushings
- glucocorticoid excess
- cause
- ACTH excess - tumor
- cortisol excess
- tumor
- exogenous glucocorticoids
List common signs of Cushings
- Buffalo hump
- thinning of skin
- thin arms and legs
- euphoria
- moon face with red cheeks
- increased abdominal fat
- easy bruising
- poor wound healing
symptoms of Addison’s disease
- adrenocorticol insufficiency
- weight loss
- hyperpigmentation
- hypotension
- hypoglycemia, salt craving
What is addisonian crisis
- acute adrenal insufficiency
- circulatory collapse, dehydration, vomiting, hyperkalemia
- fatal
What is the one Mineralocorticoid medication
-
Fludrocortisone
- increase Na+/H2O retention
two main uses for glucocroticoids medications
- replacement
- anti-inflammation
Function of Hydrocortisone
- aka cortisol
- exhibits both mineralocorticoids and glucocorticoid properties equally
indications for Hydrocortisone (Cortef)
- replacement therapy for adrenal insufficiency
Function of Cortisone (Cortone)
- exhibits both mineralocorticoid and glucocorticoid properties equally
- cortisone must first be converted to hydrocortisone in liver in order to be active
indications for Cortisone (Cortone)
replacement therapy for adrenal insufficiency
List the three drugs used for replacement therapy
- Glucocorticoid:
- Hydrocortisone (Cortef® )
- Cortisone (Cortone®)
- Mineralocorticoid:
- Fludrocortisone (generic)
List the Anti-inflammatory drugs
- Prednisone (Meticorten®)
- Prednisolone (Delta-Cortef®)
- Methylprednisolone (Medrol®)
- Triamcinolone (Aristocort®, Kenalog®)
- Betamethasone (Celestone®)
- Dexamethasone (Decadron®)
- Fluticasone (Flovent®, Flonase®)
Differentiate between Prednisone and Prednisolone
prednisone must first be converted to prednisolone in the liver in order to be active
effects of Prednisone and Prednisolone
more glucocorticoid effects than mineralocorticoid
Effects of Triamcinolone, and Methylprednisolone Dexamethasone
- high glucorcorticoid activity
- virtually no mineralocorticoid activity
list education for patients taking topical glucocorticoids
- more potent topicals -> thick skin only
- skin damage or thin skin -> increases systemic absorption
- repeated application -> depot effect
preparations of glucocorticoids
- oral: long term therapy
- injections
- inhalation
- topical
indications of Fludrocortisone
- Has both mineralocorticoid and glucocorticoid activity
- More significant mineralocorticoid effects: used as an aldosterone agonist
- Given with glucocorticoids in the treatment of adrenocortical insufficiency when more mineralocorticoid effects are needed.
How is patient with a chronic adrenal insufficiency (Addisons) treated
- tx with glucocorticoid alone or with a glucocorticoid + mineralocorticoid
dosage of replacement therapy in patient with a chronic adrenal insufficiency (Addisons) during times of stress or infection
- 2x for minor stress
- up to 10 x for major stress
Inhaled steroids have become first line treatment for
asthma
- used inconjunction with B2 agonist
Therapeutic guidelines for giving corticosteroids
- lowest effective dose
- use locally whenever possible
- give on alternate days
- decreasses suppression of HPA axis
chronic tx of corticosteroids can have what effect on HPA axis
- can cause suppression of HPA axis
- *short term therapy (1-2 weeks) is not likely to cause serious problem
List the adverse effects of corticosteroid use
- Infections
- may mask symptoms
- more susceptible to serious infection
- hyperglycemia
- may unmask diabetes
- CNS
- osteoporosis
- Cushingoid effects
List the adverse effects of corticosteroid use on CNS
- restlessness, insomina, increase appetite
- seen even with acute treatments
abrupt cessation of corticosteroids tx can cause
- acute adrenal insufficiency
- do gradual withdrawal
patients who are chronically taking corticosteroids can get what during times of stress
stress can cause adrenal crisis
list the 4 main signs of Cushingoid effects
- acne
- truncal obestiy
- buffalo hump
- moon face
contraindications to taking corticosteroids in adrenal insufficiency
NONE
contraindications to taking corticosteroids
- infection
- diabetes
- osteoporosis
- heart disease or HTN
- immunosuppressed
- childhood
- pregnancy
list the things to monitor when patient is on corticosteroids
- hyperglycemia
- Na+ retension with edema or HTN
- hypokalemia
- peptid ulcer
- osteoporosis
- infections
- growth and development in children
all agents that inhibit corticosteroids can precipitate what
acute adrenal insufficiency
List the corticosteroid synthesis inhibitors
- Aminoglutethimide
- Ketoconazole
MOA of Aminoglutethimide
- blocks adrenal and gonadal steroid synthesis
Aminoglutethimide must be given with what to suppress ACTH
corticosteroids
MOA of Ketoconazole
- antifungal that inhibits steroid synthesis at high doses
- non-selective
List the glucocorticoid receptor antagonist
- Mifepristone
MOA of Mifepristone
- antagonist of glucocorticoid and progesterone receptors
use of Mifepristone
for inoperable cushings patients
MOA of spironolactone
- Mineralocorticoid (and some androgen) receptor antagonist
- potassium sparing
use of spironolactone
- hyperaldosteronism
- hirsutism
