Corticosteroids (Exam #3) Flashcards

1
Q

Important immune system effect of Glucocorticoids?

A

ANTI-INFLAMMATORY

- Blocks all steps in inflammation (inhibits COX2)

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2
Q

Diagnosis of Cushing’s Syndrome, and what are the three steps? What do results indicate?

A

Dexamethasone Suppression Test

  1. Measure baseline cortisol in AM
  2. Administer Dexamethasone in PM
  3. Remeasure cortisol next AM

Disease if cortisol low
Syndrome if cortisol unchanged/high

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3
Q

What is the one Mineralocorticoid drug, and under what conditions should it be used?

A

Fludrocortisone

- Combine with glucocorticoid for Aldosterone replacement

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4
Q

What are the three classes of Glucocorticoids, and what are the differences between the three?

A
  • 1st class: G = M effects
  • 2nd class: G > M effects
  • Other: almost all G effects
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5
Q

Two drugs in 1st class of Glucocorticoids? Which is the active form?

A
  • Hydrocortisone (ACTIVE)

- Cortisone

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6
Q

Two drugs in 2nd class of Glucocorticoids? Which is the active form?

A
  • Prednisone

- Prednisolone (ACTIVE)

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7
Q

Two drugs in other class of Glucocorticoids?

A
  • Triamcinolone

- Methylprednisolone

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8
Q

Use of Hydrocortisone and Cortisone?

A

Replacement therapy in adrenal insufficiency

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9
Q

Use of Prednisone and Prednisolone?

A

Anti-inflammatory (more G than M effects)

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10
Q

Important note on each of the three main administrations of Glucocorticoids?

A
  • Oral: long-term therapy
  • Injections: emergency use
  • Topical: caution systemic absorption if thin skin
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11
Q

Two general treatment options for chronic Adrenal Insufficiency?

A
  • Glucocorticoid alone

- Glucocorticoid + Mineralocorticoid

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12
Q

When would treatment for chronic Adrenal Insufficiency be altered, and how?

A

Increase dose with stress or infection

  • 2x for minor
  • 10x for major (surgery, trauma)
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13
Q

If an inflammatory condition is present, what is the recommended treatment? What are three examples of inflammatory conditions?

A

GLUCOCORTICOIDS

  • Asthma
  • RA (inhaled)
  • Rhinitis (intranasal)
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14
Q

What are three therapeutic guidelines for use of Glucocorticoids?

A
  • Use lowest effective dose (taper as needed)
  • Use local if possible
  • Give on alternate days to avoid systemic AEs
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15
Q

With use of glucocorticoids, what is considered short-term therapy and what does this time frame reduce risk for?

A

1-2 weeks

- Short-term use is less likely to cause problems

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16
Q

What AE can be seen with short-term use of Glucocorticoids?

A

CNS (insomnia, restlessness)

17
Q

What three things should be monitored for with Adrenal Insufficiency and use of Glucocorticoids?

A
  • Hypokalemia
  • Na retention/edema
  • Peptic ulcers

REST of them make sense (infection, osteoporosis, hyperglycemia, poor growth/development in children)

18
Q

Use of Mifepristone?

A

Inoperable Cushing’s patients

- Acts immediately

19
Q

How does Ketoconazole differ from Mifepristone in terms of action onset?

A
  • Ketoconazole: inhibits nuclear receptors = takes time

- Mifepristone: immediate hypercortisolemia relief = works quickly

20
Q

Uses of Spironolactone (2)?

A
  • Hyperaldosteronism

- Hirsutism