FB - Corticosteroids Flashcards

1
Q

List effects of corticosteroids in airway smooth muscle.

A

Corticosteroids have numerous actions including increased expression of beta-2 adrenoceptors and reduction of expression of cytokines.

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2
Q

What is fludrocortisone?

A

Fludrocortisone is a mineralocorticoid synthetic analogue. Fludrocortisone is used to treat conditions in which the body does not produce enough of its own steroids, e.g., Addison’s disease, and salt-losing adrenogenital syndrome

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3
Q

List at least FIVE examples of pro-inflammatory gene targets decreased by corticosteroids.

A

Reduced expression of pro-inflammatory genes:
Cytokines e.g., TNF‐α,IL‐1β, IL‐2,IL‐4,IL‐5,IL‐13,IL‐33,IFNγ
Chemokines e.g., RANTES,Eotaxin,MIP‐1α,MCP‐1
Inflammatory enzymes e.g., Cyclooxygenase‐2(COX‐2), 5‐Lipoxygenase (5‐LOX), Phospholipase A2 (PLA2)
Adhesion Molecules e.g., ICAM‐1, VCAM‐1, E‐Selectin
Receptors e.g., IL‐2R (αchain), T‐CellReceptor (βchain)

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4
Q

List at least FIVE examples of anti-inflammatory gene targets increased by corticosteroids.

A
Increased expression of anti-inflammatory genes:
Annexin‐A1: A PLA2 inhibitor
β2‐adrenoceptor
IL‐1 Receptor Antagonist
IL‐1R2 (decoy receptor)
Neutral endopeptidase (NEP)
Endonucleases
IκB‐α (Inhibitor of NF‐κB)
MAPK Phosphatase‐1 (MKP‐1)
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5
Q

Name a clinically used corticosteroid with equal glucocorticoid and mineralocorticoid effects

A

Hydrocortisone (cortisol)

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6
Q

List at least THREE examples of corticosteroids with minimal or zero mineralocorticoid effect

A

Methylprednisolone, Triamcinolone, Betamethasone, Dexamethasone

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7
Q

Name an example of a highly potent corticosteroids with a long duration of action (24 to 72 hours)

A

Betamethasone, Dexamethasone

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8
Q

Name an example of a potent corticosteroid that is highly effective for topical application

A

Betamethasone

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9
Q

Name an example of a corticosteroid with a short duration of action (8 to 12 hours)

A

Hydrocortisone (cortisol)

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10
Q

List endocrine/metabolic/cardiovascular side effects of long-term treatment with corticosteroids

A

Endocrine‐Metabolic Effects:
• Hyperglycaemia (and increased risk of diabetes mellitus type II)
• Moonface, ‘buffalo hump’ & truncal obesity
• Muscle wasting
• Growth retardation (pediatric patients)
• Acne, hirsutism & menstrual disturbances
• Delayed wound healing
• Skin Thinning
• Na/fluid retention, oedema, hypertension, chronic heart failure

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11
Q

List musculoskeletal system side effects of long-term treatment with corticosteroids

A

Musculoskeletal System
• Osteoporosis (trabecular bone)
• Aseptic necrosis of femoral head
• Myopathy (esp. dexamethasone/triamcinolone)

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12
Q

List immune system side effects of long-term treatment with corticosteroids

A

Immunosuppression leading to opportunistic infections:

Bacterial (TB), Viral(Herpes&CMV), Fungal (Canadidal, Asperigilles & Crytococcal), Parasitic (Toxoplasmosis)

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13
Q

List side effects in the eye of long-term treatment with corticosteroids

A
  • Posterior Subcapsular Lens Cataract

* Glaucoma

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14
Q

List central nervous system side effects of long-term treatment with corticosteroids

A

Nervous System

• Euphoria, depression, psychosis

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15
Q

List principles of corticosteroid therapy

A
  • Host response is the cause of symptoms
  • Steroids are not usually curative
  • Standard Choice: Shorter‐acting steroids with little salt‐retaining activity (e.g., prednisolone)
  • At lowest possible dose(often still supra‐physiological) to achieve the desired effect
  • Use alternate‐day therapy or pulse therapy, if possible
  • Do not stop therapy abruptly (use gradual stepwise dose reduction)
  • In prolonged therapy, check: ches tX‐Ray, tuberculosis, diabetes mellitus, peptic ulcer disease, osteoporosis, and mental disorder
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