Corticosteroids

Question 1

Action

Answer 1

Systemic action to decrease inflammation and increase # and responsiveness of B2 receptors

Question 2

Why are they used?

Answer 2

To increase the effectiveness of B2 agonist meds

Question 3

Where do they act?

Answer 3

B2 receptors –> sympathetic NS

Question 4

MOA

Answer 4

Reduce inflammation by decreased the number of mast cells and increasing the number and responsiveness of B2 receptors

Question 5

Inhaled corticosteroids - adverse effects

Answer 5

Oral candidiasis
Dysphonia
Slowing of growth
Decreased bone density

Question 6

What is another name for oral candidiasis?

Answer 6

Thrush

Question 7

Why can oral candidiasis/thrush happen when taking an inhaled corticosteroid?

Answer 7

Some of the medication can get stuck in the mouth/oral cavity and leaves a white coating or patches on the tongue

Question 8

How is oral candidiasis/thrush tx’d?

Answer 8

Oral antifungal

Question 9

Which SEs can happen with prolonged use of an inhaled corticosteroid and especially in children?

Answer 9

Stunted growth

Decreased bone density

Question 10

Why is dysphonia a common SE of inhaled corticosteroids?

Answer 10

The vocal cords are impacted so the patient can have a scratchy voice

Question 11

Inhaled corticosteroids - clinical uses

Answer 11

Asthma maintenance

COPD maintenance

Question 12

What are some common names for inhaled corticosteroids?

Answer 12

QVAR (beclomethadone) --> MDI
Pulmicort (budesonide) ---> DPI/neb
AeroBio (flunisolide) --> MDI/DPI
Flovent (fluticasone) --> MDI/DPI
Asmanex (mometasone) --> DPI
Azmacort (triamcinolone) --> MDI

Question 13

Inhaled corticosteroids - peak effect

Answer 13

1-2 weeks

Question 14

Inhaled corticosteroids - duration

Answer 14

Most dosed 2 times daily

Question 15

Systemic corticosteroids - use

Answer 15

For severe pulmonary issue (inhaled ones are best for lung issues)
Short-term use for flares of severe cases

Question 16

Systemic corticosteroids - adverse effects - short-term use

Answer 16

Insomnia
Mental status changes (psychosis depending on use)
HYPERglycemia
ELEVATED WBC

Question 17

Systemic corticosteroids - adverse effects - long-term effects

Answer 17

HTN
Osteoporosis
Adrenal SUPPRESSION
DECREASED growth in CHILDREN

Question 18

What is another medication that someone taking a systemic corticosteroid long-term may get put on?

Answer 18

Anti-HTN (long-term use can elevate BP)

Question 19

What is another condition besides HTN that someone taking a systemic corticosteroid can develop?

Answer 19

NIDDM

Question 20

Why does adrenal suppression occur with long-term systemic corticosteroid use who is not weaned off appropriately or who is not handling being weaned off effectively?

Answer 20

The kidneys normally pulse out steroids, so oral use shuts down the adrenal glands bc the steroids are being produced externally but still being picked up in the BS - withdrawing steroid takes the adrenal glands a long time to pump out steroids again, and can cause shock because the hormones help retain BP (need to wean steroids slowly or adrenal won’t catch up - can die from adrenal suppression)

Question 21

What is a fatal SE of long-term systemic corticosteroid use?

Answer 21

ADRENAL SUPPRESSION