Corticosteroids (PE4)

Question 1

Hydrocortisone

Answer 1

Short-medium acting glucocorticoid
Has mineralocorticoid activity
T1/2: 80-118 mins
Uses: adrenocortical insufficiency, anti-inflammatory and immunosuppressive, relief of inflammation, ulcerative colitis

Question 2

Prednisone

Answer 2

Short-Medium acting glucocorticoid
Is a pro-drug, hepatic metabolism to active prednisolone
Slight mineralocorticoid activity - not good for patients with hypertension, CHF, salt retention
T1/2: 60 mins
Uses: Allergic states, autoimmune disorders, dermatologic conditions, edematous states, endocrine disorders, GI disorders, hemotologic disorders, MS, Neoplastic disease, optholmic disease, Respiratory disease, Rheumatic disorders, tuberculous meningitis

Question 3

Methylprednisolone

Answer 3

Short-medium acting glucocorticoid

Question 4

Triamcinolone

Answer 4

Intermediate acting glucocorticoid
Hepatic metabolism 
NO mineralocorticoid activity
T1/2: >200 mins
Uses: Intralesional, nasal inhalation for allergic rhinitis, ocular inflammatory conditions, bronchial asthma, oral lesions, ulcerative lesions, adrenocortical insufficiency, derm diseases, endocrine disorders, GI disease, nephrotic syndrome, rheumatic disorders, allergic states, systemic lupus erythematosus

Question 5

Dexmethasone

Answer 5

Long acting glucocorticoid
Hepatic metabolism
NO mineralocorticoid activity
T1/2: >300 mins
Uses: primarily as anti-inflammatory or immunosuppressant, conjunctivitis, inflammation of external ear canal due to otitis externa

Question 6

Metyrapone

Answer 6

Glucocorticoid synthesis inhibitor and antagonist

Question 7

Ketoconazole

Answer 7

Glucocorticoid synthesis inhibitor and antagonist

Question 8

Fludrocortisone

Answer 8

Mineralocorticoids agonist
Hepatic metabolism
Mineralocorticoid with moderate glucocorticoid activity
T1/2: >35 mins
Uses: adrenocortical insufficiency in Addison’s disease, salt-losing adrenogenital syndrome

Question 9

Spironolactone

Answer 9

Glucocorticoid AND mineralocorticoid antagonist
Competitive inhibitor of aldosterone for sites in distal renal tubules, increase sodium chloride and water secretion but CONSERVES potassium and hydrogen ions
Hepatic metabolism
Mineralocorticoid activity
T1/2 >10 mins
*can cause tumors BBwarning
Uses: Edema due to excessive aldosterone activity, HTN, CHF, primary hyperaldosteronism, hypokalemia, cirrhosis of liver w/ edema/ascites

Question 10

Cosyntropin

Answer 10

Glucocorticoid, mineralocorticoid, androgen, progesterone, and estrogen agonist
Stimulates adrenal cortex to secrete glucocorticoids, androgenic substances, and aldosterone (same as 25 U of ACTH)
Cortisol peak 60 mins post injection
Uses: diagnostic for differentiation of primary adrenal from secondary adrenocortical insufficiency