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MDRS > coticosteriod > Flashcards

coticosteriod Flashcards

1
Q

What are the Clinical Indications of ICS

A

asthma symptoms aren’t controlled

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2
Q

Where is Corticosteroids produced and example

A

adrenal cortex secretes corticosteroids:
–>glucocorticoids (cortisol)

adrenal medulla secretes catecholamines

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3
Q

What is the fxn of Glucocorticoids

A
  1. restoring metabolic demand to return to homeostasis due to stress
    - elevated blood glucose
    - gluconeogenisis
    - ->from protein and fat storage

2.anti-inflammatory and immunosuppressant actions

  • ↓ eosinophil and lymphocyte production
  • Block release of cytokines (↓ T and B cell response)
  • Stabilizes lysosome membranes
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4
Q

How is Endogenous Corticosteroids produced?

A

via hypothalamic-pituitary-adrenal (HPA) axis

  1. Stimulation of the hypothalamus –> release of CRF to anterior pitutary
  2. CRF stimulates secretion of ACTH in AP
  3. ACTH simulates the adrenal cortex to secrete glucocorticosteroids
  4. increase blood level of glucocorticosteroids will inhibit the HPA at the level of hypothalamus and anterior pituitary level
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5
Q

What is and the fxn of Mineralocorticoid

A

Aldosterone

  • conserve sodium by increases renal reabsorption
  • increased blood volume; fluid overload as side effect
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6
Q

what is adrenal suppression?

A
  • when exogenous source of glucocorticoid increase body’s level and Inhibits the hypothalamus and pituitary glands
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7
Q

What is the diurnal Steroid Cycle?

A

body’s own production of corticosteroids follows a rhythmic, 24 hrs cycle

highest after 8 am
then 1 pm and 8 pm

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8
Q

What is the MOA of Corticosteroids?

A

Steroids diffuse into cells & bind to glucocorticoid receptors (GR) to produce anti-inflammatory action by:

  1. Inducing gene expression for anti-inflammatory proteins - lipocortin
  2. suppress gene expression for pro-inflammatory proteins
  3. Inhibit cytokine (interleukin) production responsible for recruitment and migration of inflammatory cells
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9
Q

What is Corticosteroids effect on WBC count

A

Demargination: depletion of neutrophil stores reduces their accumulation at inflammatory sites and in exudates

increase WBC count

Constriction of microvasculature to reduce leakage of cells and fluids into inflammatory sites

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10
Q

What is the effect of inflammation

A

Produces general symptoms of redness, swelling heat and pain via

  1. Increased vascular permeability
    - ->increase Exudate in surrounding tissue
  2. Leukocytic infiltration
    - ->WBC’s invade in response to chemotaxis
  3. Phagocytosis
    - ->WBC’s & macrophages digest foreign matter in the lungs
  4. Inflammatory mediator cascade
    - ->histamine and arachidonic acid products are generated
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11
Q

how does steriod inhibit the prevention of arachidonic acid?

A

Steroids increase the synthesis of lipocortin, a phospholipase A2 inhibitor

as a result, this prevents arachidonic acid taking the leukotriene and prostaglandin pathway

–>lead to decrease inflammation and reduce hyper-responsiveness of airways

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12
Q

What is the result of Airway Inflammation

A

edema
mucous
increased microvascular permeability (leakage), bronchospasm

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13
Q

How to avoid side effect of ICS

A

Use of spacer, gargling/brushing teeth after

oral thrush from candida albicans

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14
Q

What are the side effect of systemic steroid

A 
suppression of HPA axis
immunosuppression
osteoporosis
cushingoid effects**
diabetes due to hyperglycemia via gluconeogenesis
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15
Q

What is the cushingoid effects

A
  • moon face” and weight gain from fluid retention
  • ->lead to hypertension
  • buffalo hump” from fat mobilization
  • protein & muscle wasting due to catabolic effects of cortisol
  • masculinization
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16
Q

What is the goal between system and inhaled corticosteriod

A

in lung disease–> switch from systemic to oral to reduce side effects

17
Q

When to start switch

A

after more than 10 days of systemic steroids

there is adrenal insufficiency so
slow tapering allows HPA axis to begin to function normally

18
Q

how to provide corticosteroid therapy?

A

give intermediate acting (12-36 hrs) steroid in am when body natural steroid levels are high

  • skip steroids next day, so body can resume natural steroid production
19
Q

What are the systemic short acting corticosteriod agents

A

Hydrocortisone(Solucortef)

Cortisone(Cortone)

20
Q

What are the intermediate acting corticosteriod agents

A

Methylprednisolone(Solu-Medro IV) or (Depo-Medrol - IM)

Prednisone (Pediapred)

21
Q

What are the long acting corticosteriod agents

A

Dexamethasone (Decadron

22
Q

How long is short acting SCS?

A

8 - 12 hrs

23
Q

how long is intermediate acting SCS ?

A

12 - 36 hrs

24
Q

How long is long acting SCS?

A

36 -72hrs

25
Q

Characterisitc of SASCS (indication, dose, adminstration)

A

*Hydrocortisone(Solucortef)
Cortisone(Cortone)

-IV
- Indication
adrenal insufficiency
asthma

  • significant mineralcorticoid activity
  • histamine and bradykinin
26
Q

Characterisitc of Methylprednisolone(indication, dose, adminstration)

A

Methylprednisolone
(Solu-Medrol - IV) , (Depo-Medrol - IM)

  • relative potency 5 x that of endogenous glucocorticoids

INdication

  • acute asthmatics in ER to suppress 2nd inflammatory phase
  • inhibit Arachidonic Acid within 4-6 hours to be effective in the late stage
27
Q

Characterisitc of Prednisone(indication, dose, adminstration)

A

(Pediapred)

  • Oral

-dose:
5-60mg/day PO in single or divided doses

Indication

  • acute asthma
  • COPD
  • IPF
28
Q

Characterisitc of Dexamethasone(indication, dose, adminstration)

A

Brand: decadron

Route
oral, IV, IM, nasal MDI

  • synthetic
  • extremely potent (20x) glucocorticoid activity
  • virtually no mineralocorticoid activity
29
Q

What is the deal with ICS treatment for acute respiratory exacerbation?

A

Depending on acuity

  • ->severe : go IV
  • ->can tolerate: ORAL

If improvement in 48-72 hrs
–>IV taper to oral for 2WKS

30
Q

What is the Indications for ICS

A
  1. treatment of steroid-responsive asthma and COPD
  2. maintenance (controller/prophylactic) drug in asthma
  3. useful to help prevent exacerbations in COPD
31
Q

What is the Adverse Effects of ICS

A

dysphonia
cough
pharyngeal yeast infection: candida albicans

32
Q

What are some ICS drugs?

A 
Beclomethasone dipropionate - OVAR
Budesonide -  (Pulmicort)
Ciclesonide - Alvesco®
Fluticasone propionate - (Flovent)
Fluticasone Furoate - (Arnuity)
mometasone - TwisthalerTM
33
Q

What is the form, schedule and L,M,H dose of Beclomethasone, Budesonide, Fluticasone (flovent)

A

MDI (50μg/puff or 100μg/puff)

schedule
1-2 puffs/inhalations BID

Low dose
<250mcg

Mid dose
251-500

high
>500

34
Q

What are some combined agents

A
  1. Fluticasone propionate + salmeterol - advair
  2. Budesonide + formoterol -symbicort
  3. mometasone (ICS) + formoterol (LABA) -zenhale
35
Q

What is the brand name, generic name and dose of 1 combine agent

A

Brand
Symbicort

Generic
Budesonide + formoterol

dose
100/6mcg or 200/6mcg

MDRS (23 decks)

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