coticosteriod Flashcards
What are the Clinical Indications of ICS
asthma symptoms aren’t controlled
Where is Corticosteroids produced and example
adrenal cortex secretes corticosteroids:
–>glucocorticoids (cortisol)
adrenal medulla secretes catecholamines
What is the fxn of Glucocorticoids
- 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
How is Endogenous Corticosteroids produced?
via hypothalamic-pituitary-adrenal (HPA) axis
- Stimulation of the hypothalamus –> release of CRF to anterior pitutary
- CRF stimulates secretion of ACTH in AP
- ACTH simulates the adrenal cortex to secrete glucocorticosteroids
- increase blood level of glucocorticosteroids will inhibit the HPA at the level of hypothalamus and anterior pituitary level
What is and the fxn of Mineralocorticoid
Aldosterone
- conserve sodium by increases renal reabsorption
- increased blood volume; fluid overload as side effect
what is adrenal suppression?
- when exogenous source of glucocorticoid increase body’s level and Inhibits the hypothalamus and pituitary glands
What is the diurnal Steroid Cycle?
body’s own production of corticosteroids follows a rhythmic, 24 hrs cycle
highest after 8 am
then 1 pm and 8 pm
What is the MOA of Corticosteroids?
Steroids diffuse into cells & bind to glucocorticoid receptors (GR) to produce anti-inflammatory action by:
- Inducing gene expression for anti-inflammatory proteins - lipocortin
- suppress gene expression for pro-inflammatory proteins
- Inhibit cytokine (interleukin) production responsible for recruitment and migration of inflammatory cells
What is Corticosteroids effect on WBC count
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
What is the effect of inflammation
Produces general symptoms of redness, swelling heat and pain via
- Increased vascular permeability
- ->increase Exudate in surrounding tissue - Leukocytic infiltration
- ->WBC’s invade in response to chemotaxis - Phagocytosis
- ->WBC’s & macrophages digest foreign matter in the lungs - Inflammatory mediator cascade
- ->histamine and arachidonic acid products are generated
how does steriod inhibit the prevention of arachidonic acid?
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
What is the result of Airway Inflammation
edema
mucous
increased microvascular permeability (leakage), bronchospasm
How to avoid side effect of ICS
Use of spacer, gargling/brushing teeth after
oral thrush from candida albicans
What are the side effect of systemic steroid
suppression of HPA axis immunosuppression osteoporosis cushingoid effects** diabetes due to hyperglycemia via gluconeogenesis
What is the cushingoid effects
- 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
What is the goal between system and inhaled corticosteriod
in lung disease–> switch from systemic to oral to reduce side effects
When to start switch
after more than 10 days of systemic steroids
there is adrenal insufficiency so
slow tapering allows HPA axis to begin to function normally
how to provide corticosteroid therapy?
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
What are the systemic short acting corticosteriod agents
Hydrocortisone(Solucortef)
Cortisone(Cortone)
What are the intermediate acting corticosteriod agents
Methylprednisolone(Solu-Medro IV) or (Depo-Medrol - IM)
Prednisone (Pediapred)
What are the long acting corticosteriod agents
Dexamethasone (Decadron
How long is short acting SCS?
8 - 12 hrs
how long is intermediate acting SCS ?
12 - 36 hrs
How long is long acting SCS?
36 -72hrs
Characterisitc of SASCS (indication, dose, adminstration)
*Hydrocortisone(Solucortef)
Cortisone(Cortone)
-IV
- Indication
adrenal insufficiency
asthma
- significant mineralcorticoid activity
- histamine and bradykinin
Characterisitc of Methylprednisolone(indication, dose, adminstration)
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
Characterisitc of Prednisone(indication, dose, adminstration)
(Pediapred)
- Oral
-dose:
5-60mg/day PO in single or divided doses
Indication
- acute asthma
- COPD
- IPF
Characterisitc of Dexamethasone(indication, dose, adminstration)
Brand: decadron
Route
oral, IV, IM, nasal MDI
- synthetic
- extremely potent (20x) glucocorticoid activity
- virtually no mineralocorticoid activity
What is the deal with ICS treatment for acute respiratory exacerbation?
Depending on acuity
- ->severe : go IV
- ->can tolerate: ORAL
If improvement in 48-72 hrs
–>IV taper to oral for 2WKS
What is the Indications for ICS
- treatment of steroid-responsive asthma and COPD
- maintenance (controller/prophylactic) drug in asthma
- useful to help prevent exacerbations in COPD
What is the Adverse Effects of ICS
dysphonia
cough
pharyngeal yeast infection: candida albicans
What are some ICS drugs?
Beclomethasone dipropionate - OVAR Budesonide - (Pulmicort) Ciclesonide - Alvesco® Fluticasone propionate - (Flovent) Fluticasone Furoate - (Arnuity) mometasone - TwisthalerTM
What is the form, schedule and L,M,H dose of Beclomethasone, Budesonide, Fluticasone (flovent)
MDI (50μg/puff or 100μg/puff)
schedule
1-2 puffs/inhalations BID
Low dose
<250mcg
Mid dose
251-500
high
>500
What are some combined agents
- Fluticasone propionate + salmeterol - advair
- Budesonide + formoterol -symbicort
- mometasone (ICS) + formoterol (LABA) -zenhale
What is the brand name, generic name and dose of 1 combine agent
Brand
Symbicort
Generic
Budesonide + formoterol
dose
100/6mcg or 200/6mcg
