Corticosteroids (Non-DMARD RA Tx) Flashcards
What are some advantages of corticosteroids?
Inexpensive, can inject into joint spaces
In addition to suppressing signs and sx of RA what else do they do?
They appear to have a disease modifying effect, at least in early RA
What happens after discontinuation of treatment with corticosteroids?
Disease modifying effects persist, specifically articular erosions
What can be said about the ADE’s of corticosteroids?
They are often overestimated
If corticosteroids are give in accordance with physiological circadian rhythms, what happens?
It may bring safety and efficacy benefits because it is being administered with normal cortisol which may reduce endocrine suppression that is seen with traditional corticosteroid treatment
What is the MOA of corticosteroids?
Binding cytosolic glucocorticoid receptors and translocate to the nucleus where they act to inhibit NF-kB, AP-1, and NFAT which decrease inflammatory cytokines IL-1, IL-6 and TNF-a. This inhibits RANKL, which is responsible for osteoclast activation
What do the majority of anti-inflammatory effects occur via with corticosteroids?
cytosolic GC receptors (cGCRs)
Additionally, how may corticosteroids exert effects?
Rapid, non-genomic mechanisms (action on Src and intercalation into plasma and mitochondrial membranes)
What are the ADEs of glucocorticoids dependent on and what kind of monitoring must take place?
They are dependent on cumulative and daily dose as well as high/low dose; Coadmin of DMARDS can increase ADE’s; Increased monitoring for high doses (monitor everyone for osteoporosis, glaucoma, and ankle edema).
If a corticosteroid is given with an NSAID what can happen?
Peptic ulcer dz (give a PPI)
What can the corticosteroids “mess with” in regards to their daily monitoring?
It messes with lipid profiles, glucose regulation, and inculin response which increases CV ADE’s (RA pts already at increased risk for CV) and increase risk of infection.
What is the equivalent dose of corticosteroids adjusted on?
Potency; only short acting have mineralocorticoid activity (NA/H2O retention)
What is the potency of all corticosteroids based off of?
Hydroxycortisone
What is the action duration and activity of Hydroxycortisone?
Short acting, Anti-inflamm and salt-rention = 1, oral dose = 20mg (oral/IV)
What is the action duration and activity of Cortisone?
Short acting, .8 Anti inflam/salt retention = 25 mg, oral