Glucocorticoids Flashcards
Glucocorticoid prototypes to know:
- Prednisone
- Methylprednisolone (Solumedrol)
- Inhaled/Intranasal (next semester)
long term vs short term use glucocorticoids what is the duration?
- long term = >3 week
- short term = 2-3 week
What is IV formulation of glucocorticoid?
Methylprednisone (solumedrol)
Indication for use of glucocorticoids?
suppress IMMUNE and INFLAMMATION response
Indication for use of glucocorticoids?
suppress INFLAMMATION and IMMUNE response
3 ways glucocorticoids function:
- inhibit synthesis of chemical mediators like prostaglandins, leukotrienes, histamine
- suppress infiltration of phagocytes
- suppress proliferation of lymphocytes (–> decrease immune component of inflammation)
What is the best drug to suppress immune and inflammation processes?
glucocorticoids
What happens when you use glucocorticoids long term and you have an injury?
- decrease inflammatory response (swelling, redness, pain, warmth)
- –> harder to detect inflammatory response
- –> increase risk of infection
Whats up with long term use glucocorticoids and vaccines?
- decrease effectiveness of vaccine
- don’t want them to have live virus vaccine
- —wait until pt is off steroids to get vaccine b/c of decrease inflamm response
- —need them to get vaccinated b/c of decrease immune response
someone who uses glucocorticoids long term is considered ______
immunocompromised
List a bunch of stuff glucocorticoids treat (10)!
- Rheumatoid Arthritis
- Lupus
- Tendonitis
- Nausea/Emesis
- Organ transplant
- Asthma
- Cancer
- Preterm Infants
- Drug Allergy
- COPD
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Tell me about how glucocorticoids work on pharmokinetic level. What it doing to your tiny little cells?
- glucocorticoid receptors are INSIDE the cell (not on the surface)
- Receptor is CONVERTED to an ACTIVE form by glucocorticoid
- Receptor complex MIGRATES to NUCLEUS
- CHANGE behavior at TARGET GENES
When is onset of action for glucocorticoids?
hours!
-no immediate action even when given IV
List all the side effects from long term use of glucocorticoids
- Hyperglycemia
- Edema/retention
- Cushinoid syndrome
- Osteoporosis
- Capillary fragility
- Thinned skin w/ purpura
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List the short term/high dose glucocorticoid side effects
- increase appetite
- insomnia
- hyperactivity
- hallucinations
- mood change
- mania
3 ways glucocorticoids contribute to hyperglycemia
- increase synthesis of glucose from amino acids
- decrease peripheral glucose utilization
- decrease glucose uptake by muscles/adipose tissue
If we are concerned about hyperglycemia with steroids what do we do?
-check CNG regularly and treat if elevated
how do glucocorticoids cause edema/retention? and what we gunna do bout it?
mineral corticod activity –> Na/H2O retention + decrease K
—monitor electrolytes and replace as needed
Omg there are so many sxs of cushing’s syndrome that can come from glucocorticoids long term usage. List some
-hyperglycemia
-fluid electrolyte imbalance
-osteoporosis
-muscle weakness
external physical changes:
pot belly, moon face, buffalo hump, thinning of limbs, abd stiae, bruising
what we gunna do bout cushings syndrome and glucocorticoids?
-decrease drug therapy if possible to decrease sxs/reverse sxs
3 ways glucocorticoids lead to osteoporosis?
- Decrease osteoBLast
- Increase osteoCLast
- decrease intestinal absorption of Ca
- –> hypocalcemia
- –> parathyroid hormone increase Ca level in bones
-got ourselves a vicious cycle here
Onset of osteoporosis from glucortoicoids?
-bone density lost occurs within weeks
what we gunna do bout osteoporosis from glucocorticoids?
-give Ca, Vit D, and do bone density scans
Why do I care about capillary fragility from glucocorticoids?
b/c IV sites won’t last long and I’ll have to start a new one
What drugs not to mix with glucocorticoids?
- furosemide/ lasix b/c of low K risk
- NSAID/Aspirin b/c of risk of peptic ulcers
When it comes time to stop taking glucocorticoids, what are the considerations for long term and short term use?
long term = slow withdrawal
short term = no problem to stop immediately
What are the sxs of withdrawal from glucocorticoids?
Adrenal Insufficiency:
- hypotension
- hypoglycemia
- myalgia
- arthralgia
- fatigue
Why do you have adrenal insufficiency with glucocorticoid long term use?
- steroid meds decrease adrenal gland output
- need to give adrenal glands time to reactivate so slow withdrawal from steroid meds
If someone is in a critical stress situation like an accident and takes chronic steroids then their need for steroids______
increases b/c adrenal glands have limited output
How do you give oral glucocorticoid prednisone? Why?
- w/ food or milk to decrease peptic ulcer disease
* don’t mix with aspirin or NSAID b/c those also have PUD risk
What time of day we gunna give glucocorticoids? Why?
9 AM - mimics adrenal gland natural output
Why would we give alternate day dosing of glucocorticoids?
given to promote adrenal recovery
