Corticosteroids - Respiratory Glucocorticoids Flashcards
There are 3 layers to the adrenal glands:
- zona glomerulus
- zona fasiculata
- zona reticularis
Match the above layers with what they synthesise and release?
- glucocorticoids
- androgens
- mineralcorticoids
- zona glomerulus =
- mineralcorticoids
- zona fasiculata = glucocorticoids
- zona reticularis = androgens
The deeper you get the sweeter it gets
Where in the adrenal gland is adrenaline and noradrenaline synthesised and released?
1 - zona glomerulus
2 - zona fasiculata
3 - medula (chromaffin cells)
3 - zona reticularis
3 - medula (chromaffin cells)
Steroids are typically cholesterol based, meaning they are lipophilic. This means that are able to diffuse into cells freely. Once they pass into the cell they are able to elicit actions. Organise the following into what happens within the cells?
1 - diffuse into cell membrane due to small size and hydrophobic nature
2 - cell undergoes transcription and protein synthesis
3 - hormone receptor complex enters the nucleus and cytoplasmic receptor aspect of the hormone receptor complex binds to DNA
4 - steroid hormone binds with cytoplasmic receptor forming hormone receptor complex
5 - hormone receptor complex binds to specific parts of DNA and genes can be turned on or off
1 - diffuse into cell membrane due to small size and hydrophobic nature
4 - steroid hormone binds with cytoplasmic receptor forming hormone receptor complex
3 - hormone receptor complex enters the nucleus and cytoplasmic receptor
5 - hormone receptor complex binds to specific parts of DNA and genes can be turned on or off
2 - cell undergoes transcription and protein synthesis
Which of the following are the 2 core glucocorticoids that we need to be aware of that can be prescribed orally to asthma and COPD patients?
1 - prednisolone
2 - dexamethasone
3 - beclomethasone
4 - fluticasone
1 - prednisolone
2 - dexamethasone
Which of the following is NOT a core glucocorticoids that we need to be aware of that can be prescribed as an inhaler in asthma and COPD patients?
1 - prednisolone
2 - budesonide
3 - beclomethasone
4 - fluticasone
1 - prednisolone
- generally prescribed orally
Which 2 of the following are core glucocorticoids that we need to be aware of that can be prescribed as IV in asthma and COPD patients?
1 - prednisolone
2 - budesonide
3 -methylprednisolone
4 - hydrocortisone
3 -methylprednisolone
4 - hydrocortisone
Depending on the patients symptoms, we can prescribe combinations of drugs to treat patients with asthma and COPD, including LABA, LAMA and inhaled corticosteroids. Which of the following is NOT a inhaled corticosteroid combined with a LABA?
1 - formoterol/budesonide (Symbicort)
2 - salbutamol/beclomethasone
3 - formoterol/beclomethasone (Fostair)
4 - salmeterol/fluticasone (Seretide)
2 - salbutamol/beclomethasone
- SABA and inhaled corticosteroid
- formoterol + salmeterol = LABA
- beclomethasone, fluticasone and budesonide = inhaled corticosteroid
Depending on the patients symptoms, we can prescribe combinations of drugs to treat patients with asthma and COPD, including LABA + LAMA combination. Which 2 of the following is NOT a LABA + LAMA combination?
1 - tiotropium/olodaterol (Stiolto respimat)
2 - Fluticasone/vilanterol (Relvar ellipta)
3 - formoterol/budesonide (Symbicort)
4 - salmeterol/fluticasone (Seretide)
1 - tiotropium/olodaterol (Stiolto respimat)
2 - Fluticasone/vilanterol (Relvar ellipta)
- tiotropium = LAMA
- fluticasone = LABA
- olodaterol and vilanterol = inhaled corticosteroids
Depending on the patients symptoms, we can prescribe combinations of drugs to treat patients with asthma and COPD, including LABA + LAMA + inhaled corticosteroid. Which of the following is a typical combined used clinicaly?
1 - tiotropium/olodaterol / glycopyrronium (Stiolto respimat)
2 - Fluticasone/vilanterol / olodaterol(Relvar ellipta)
3 - formoterol/budesonide / vilanterol(Symbicort)
4 -beclomethasone / formoterol /glycopyrronium (Trimbow)
4 -beclomethasone / formoterol /glycopyrronium (Trimbow)
- beclomethasone = inhaled corticosteroid
- formoterol = LABA
- glycopyrronium = LAMA
What is the mechanism of action of glucocorticoids in the respiratory tract?
1 - inhibit adenylyl cyclase
2 - bind DNA and down-regulate genes associated with inflammation and up-regulate anti-inflammatory genes
3 - inhibit phospholipase C
4 - inhibit IgE
2 - bind DNA and down-regulate genes associated with inflammation and up-regulate anti-inflammatory genes
- this causes immunosuppression though
In respiratory medicine corticosteroids can be used for lots of reasons. What are the 2 main effects of these drugs?
1- anti-inflammatory
2 - IgE modulation
3 - vasodilation
4 - increased mucus production
1- anti-inflammatory
3 - vasodilation
Which of the following is NOT a benefit of giving a patient corticosteroids via oral or IV routes?
1 - systemic effects
2 - strong and fast acting effects
3 - not affected by inhaler technique
4 - localised at site of administration
5 - more effective in acute and severely ill patients
4 - localised at site of administration
What is the major issue with administering corticosteroids via IV or orally?
1 - expensive
2 - difficult to cannulate
3 - increased risk of side effects
4 - poor systemic effects
3 - increased risk of side effects
Beclomethasonem, fluticasone and budesonide are all inhaled corticosteroid. Although these drugs are very effective, which of the following is NOT a common side effect?
1 - tachycardia
2 - reduced immune effect
3 - fungal infections occur (oral candidiasis)
4 - dysphonia (horse voice)
1 - tachycardia
Oral candidiasis (fungal infection) is a common side effect when giving glucocorticoids, beclomethasonem, fluticasone and budesonide as an inhaler, how can this be minimised for patients?
1 - try to swallow quickly
2 - mouthwash after taking
3 - ensure good inhaler technique
4 - taken it orally instead
2 - mouthwash after taking
- using spacers can also help
