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PPP 3 > Glucocorticoids > Flashcards

Glucocorticoids Flashcards

1
Q

Cortisol Effects

A

-Decrease inflammation
-Increase glucose

Increases cellular fuel sources

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2
Q

Glucocorticoid Production in Adrenal Gland

A
  1. Androgens = zona Reticularis
  2. Glucocorticoids = zona Fasciculata
  3. Mineralcorticoids = zona Glomerulosa
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3
Q

Symptoms of Cortisol Deficiency

A
  1. Hypoglycemia
  2. Weight loss, nausea, anorexia
  3. Hypotension
  4. Anemia, weakness
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4
Q

Symptoms of Cortisol Excess

A
  1. Insulin resistance, hyperglycemia
  2. Stria in skin, limb muscle wasting, bruising
  3. Deposition of fat
  4. Weight gain
  5. Hypertension
  6. Easy bruising, osteoporosis, muscle weak
  7. Increase risk of infections
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5
Q

Aldosterone Effects

A

-Increases sodium reabsorption (water)
-Increases K excretion

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6
Q

Symptoms of Aldosterone Deficiency

A
  1. Hypotension, hyponatremia
  2. Hyperkalemia
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7
Q

Symptoms of Aldosterone Excess

A
  1. Hypertension, hypernatremia
  2. Hypokalemia
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8
Q
  • Corticosteroids = _____
  • Glucocorticoid = ____
  • Mineralocorticoid = ____
A

-Steroid hormones
-Cortisol
-Aldosterone

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9
Q

Cortisol Effects at MR/GR

A

Increase Na retention and Increase K excretion

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10
Q

Indications for Corticosteroids

A

CHAI + II

  1. Endocrine Disorders (Cushing’s, hyperplasia, adrenal insufficiency)
  2. Nonendocrine Disorders
    -inflammatory (osteoarth, UC/CD, rhinitis, asthma)
    -immunological (rheumatoid arth, sclerosis, organ transplant)
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11
Q

Corticosteroids Adverse Effects

A

HHHE WOGG

  1. HPA suppression
  2. Weight gain
  3. Glucose intolerance
  4. Edema, HTN
  5. Hypokalemia
  6. Osteoporosis
  7. Ulcer, GI bleeding
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12
Q

Corticosteroids CI and Precautions

A

PODS HCPC

– Systemic infections* (e.g. tuberculosis, herpes lesions)
– Diabetes mellitus
– Peptic ulcer
– Osteoporosis
– Heart failure and hypertension
– Cataracts and glaucoma
– Pregnancy
– CNS disorders (psychosis)

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13
Q

Checklist prior to the usage of corticosteroids

A

– Presence of tuberculosis or other chronic infection
(chest-x-ray, tuberculin test)
– Evidence of glucose intolerance
– Evidence of pre-existing osteoporosis
– History of peptic ulcer or gastritis (stool guaiac test)
– Evidence of hypertension, cardiovascular disease, or hypertriglyceridemia
– History of psychological disorders

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14
Q

Corticosteroids Monitoring

A
  • Blood pressure
  • Glucose
  • Electrolytes (Na and K)
  • Weight
  • Stool for occult blood
  • Yearly eye exam
  • Growth in children and adolescents
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15
Q

Corticosteroids DDI

A

NDDA CLC

  • NSAIDS
  • Diabetic agents
  • Drugs affecting K (diuretics, digoxin)
  • Antihypertensive meds
  • CYP inducers (pheny/pheno)
  • CYP inhibitors (ritonavir/keto)
  • Live vaccines
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16
Q

Dosing Considerations

A

Corticosteroids should be administered first thing in the morning before 9 AM (adrenal glands secrete most of the corticosteroids in the morning)

17
Q

Considerations before starting corticosteroid therapy:

A

– Ratio of glucocorticoid and mineralocorticoid activity
– Route of administration

18
Q

Whenever possible, use to minimize systemic effects:

A
  • Inhalation therapy for asthma
  • Topical application for inflammatory skin disorders
19
Q

Parenteral glucocorticoids: Hydrocortisone, methylprednisolone, triamcinolone, betamethasone, dexamethasone

A

– Mainly used for emergencies (acute adrenal crisis)
– Agent of choice: hydrocortisone (has GC and MC activity!)

20
Q

Oral glucocorticoids: Hydrocortisone, prednisone, prednisone, methylprednisolone, dexamethasone

A

AIAI OTCT

– Adrenal insufficiency
– Inflammatory and autoimmune diseases (e.g. asthma, IBD, RA)
– Solid organ transplantation (used for immunosuppression)
– Chemotherapy (especially for certain lymphoid malignancies)

21
Q

Inhaled glucocorticoids: Triamcinolone

A

– Asthma (administered by inhalation)
– Allergic and non-allergic rhinitis (administered by nasal inhalation)
– COPD (administered by inhalation)

22
Q

Topical glucocorticoids: hydrocortisone, triamcinolone, betamethasone, dexamethasone

A
  • General:
    – Safest for chronic application
  • Clinical use:
    – Inflammatory dermatoses (eczema, psoriasis)
  • MOA: see cortisol
  • Adverse effects: see cortisol
23
Q

Mineralocorticoid agonists: Fludrocortisone

A

don’t ADD SALT bc of CARDIO

  • Clinical use:
    – Adrenal insufficiency (Addison’s disease)
  • MOA:
    – Very potent mineralocorticoid; used primarily for its mineralocorticoid effects
  • Adverse effects:
    – Salt and fluid retention
    – Hypertension
    – Heart failure
24
Q

Mineralocorticoid agonists: Spironolactone

A
  • Clinical use:
    – Primary hyperaldosteronism
    – Hypokalemia
    – Heart failure
  • MOA: Antagonist at the mineralocorticoid receptor
  • Adverse effects:
    – Hyperkalemia
    – Hyponatremia
    – Gynecomastia

PPP 3 (22 decks)

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