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Pharm 313 > Glucocorticoids > Flashcards

Glucocorticoids Flashcards

1
Q

Glucocorticoid prototypes to know:

A
  1. Prednisone
  2. Methylprednisolone (Solumedrol)
  3. Inhaled/Intranasal (next semester)
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2
Q

long term vs short term use glucocorticoids what is the duration?

A
  • long term = >3 week

- short term = 2-3 week

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3
Q

What is IV formulation of glucocorticoid?

A

Methylprednisone (solumedrol)

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4
Q

Indication for use of glucocorticoids?

A

suppress IMMUNE and INFLAMMATION response

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5
Q

Indication for use of glucocorticoids?

A

suppress INFLAMMATION and IMMUNE response

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6
Q

3 ways glucocorticoids function:

A
  1. inhibit synthesis of chemical mediators like prostaglandins, leukotrienes, histamine
  2. suppress infiltration of phagocytes
  3. suppress proliferation of lymphocytes (–> decrease immune component of inflammation)
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7
Q

What is the best drug to suppress immune and inflammation processes?

A

glucocorticoids

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8
Q

What happens when you use glucocorticoids long term and you have an injury?

A
  • decrease inflammatory response (swelling, redness, pain, warmth)
  • –> harder to detect inflammatory response
  • –> increase risk of infection
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9
Q

Whats up with long term use glucocorticoids and vaccines?

A
  • 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
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10
Q

someone who uses glucocorticoids long term is considered ______

A

immunocompromised

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11
Q

List a bunch of stuff glucocorticoids treat (10)!

A
  1. Rheumatoid Arthritis
  2. Lupus
  3. Tendonitis
  4. Nausea/Emesis
  5. Organ transplant
  6. Asthma
  7. Cancer
  8. Preterm Infants
  9. Drug Allergy
  10. COPD
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12
Q

Tell me about how glucocorticoids work on pharmokinetic level. What it doing to your tiny little cells?

A
  • 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
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13
Q

When is onset of action for glucocorticoids?

A

hours!

-no immediate action even when given IV

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14
Q

List all the side effects from long term use of glucocorticoids

A
  1. Hyperglycemia
  2. Edema/retention
  3. Cushinoid syndrome
  4. Osteoporosis
  5. Capillary fragility
  6. Thinned skin w/ purpura

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15
Q

List the short term/high dose glucocorticoid side effects

A
  1. increase appetite
  2. insomnia
  3. hyperactivity
  4. hallucinations
  5. mood change
  6. mania
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16
Q

3 ways glucocorticoids contribute to hyperglycemia

A
  1. increase synthesis of glucose from amino acids
  2. decrease peripheral glucose utilization
  3. decrease glucose uptake by muscles/adipose tissue
17
Q

If we are concerned about hyperglycemia with steroids what do we do?

A

-check CNG regularly and treat if elevated

18
Q

how do glucocorticoids cause edema/retention? and what we gunna do bout it?

A

mineral corticod activity –> Na/H2O retention + decrease K

—monitor electrolytes and replace as needed

19
Q

Omg there are so many sxs of cushing’s syndrome that can come from glucocorticoids long term usage. List some

A

-hyperglycemia
-fluid electrolyte imbalance
-osteoporosis
-muscle weakness
external physical changes:
pot belly, moon face, buffalo hump, thinning of limbs, abd stiae, bruising

20
Q

what we gunna do bout cushings syndrome and glucocorticoids?

A

-decrease drug therapy if possible to decrease sxs/reverse sxs

21
Q

3 ways glucocorticoids lead to osteoporosis?

A
  1. Decrease osteoBLast
  2. Increase osteoCLast
  3. decrease intestinal absorption of Ca
    - –> hypocalcemia
    - –> parathyroid hormone increase Ca level in bones

-got ourselves a vicious cycle here

22
Q

Onset of osteoporosis from glucortoicoids?

A

-bone density lost occurs within weeks

23
Q

what we gunna do bout osteoporosis from glucocorticoids?

A

-give Ca, Vit D, and do bone density scans

24
Q

Why do I care about capillary fragility from glucocorticoids?

A

b/c IV sites won’t last long and I’ll have to start a new one

25
Q

What drugs not to mix with glucocorticoids?

A
  • furosemide/ lasix b/c of low K risk

- NSAID/Aspirin b/c of risk of peptic ulcers

26
Q

When it comes time to stop taking glucocorticoids, what are the considerations for long term and short term use?

A

long term = slow withdrawal

short term = no problem to stop immediately

27
Q

What are the sxs of withdrawal from glucocorticoids?

A

Adrenal Insufficiency:

  • hypotension
  • hypoglycemia
  • myalgia
  • arthralgia
  • fatigue
28
Q

Why do you have adrenal insufficiency with glucocorticoid long term use?

A
  • steroid meds decrease adrenal gland output

- need to give adrenal glands time to reactivate so slow withdrawal from steroid meds

29
Q

If someone is in a critical stress situation like an accident and takes chronic steroids then their need for steroids______

A

increases b/c adrenal glands have limited output

30
Q

How do you give oral glucocorticoid prednisone? Why?

A
  • w/ food or milk to decrease peptic ulcer disease

* don’t mix with aspirin or NSAID b/c those also have PUD risk

31
Q

What time of day we gunna give glucocorticoids? Why?

A

9 AM - mimics adrenal gland natural output

32
Q

Why would we give alternate day dosing of glucocorticoids?

A

given to promote adrenal recovery

Pharm 313 (26 decks)

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