Corticosteroids Flashcards
1
Q
Physiologic effects of aldosterone?
A
Increases Na+/H2O absorption and K+/H+ excretion
2
Q
Physiologic effects of cortisol?
A
- Regulates stress
- Regulates metabolism
- Immune function
- Mediates inflammatory response
3
Q
Metabolic effects of cortisol?
A
- Increased gluconeogenesis, decreased glucose uptake in peripheral tissues
- Increased glycogen deposition
- Increase lipogenesis > increase lipolysis
- Water retention
4
Q
How are aldosterone and cortisol regulated?
A
Aldosterone: RAAS, ACTH
Cortisol: Feedback inhibition by hypothalamus-pituitary-adrenal axis
5
Q
Examples of corticosteroids?
A
- Cortisone*
- Hydrocortisone*
- Prednisone*
- Prednisolone
- Methylprednisone
- Triamcinolone
- Dexmethasone
- Bethamethasone
*Prodrugs
6
Q
Anti-inflammatory effects of corticosteroids?
A
- Decreases circulating T cells, B cells, monocytes, basophils and eosinophils via increased apoptosis
- Increases circulating neutrophils via increased production and decrease extravasation
- Increased macrophage phagocytosis and promotion of resolution of inflammation
- Decreased lymphoid tissue in lymph nodes
- Decreased type 4 hypersensitivity reactions
- 1st choice of immunosuppressant for SOT and HSCT
- Greater effects on cellular than humoral immunity
7
Q
AEs of steroid therapy
A
Iatrogenic cushing’s syndrome
- Hyperglycaemia
- Moon face, buffalo hump, truncal obesity
- Delayed wound healing
- Skin thinning (upon topical application due to decreased collagen synthesis )
- Growth retardation in children
- Muscle wasting
- Acne, hirsutism, mental disturbances
- Na+/H2O retention, oedema, HTN, CHF
8
Q
What are some principles of steroid therapy?
A
- Taper dose gradually, do not stop abruptly; Need to ensure endogenous cortisol production resumes
- Use as low dose as possible
- Steroids are not usually curative
9
Q
Effects of excess aldosterone
A
- Hypernatremia
- Hypokalemia
- Metabolic alkalosis
- Oedema
