Glucocorticoids

Question 1

What are indications for corticosteroids?

Answer 1

1. Replacement therapy: treatment for adrenal insufficiency and congenital hyperplasia
   - Addison’s (primary adrenal insufficiency)
2. Diagnosis of Cushing’s syndrome
   - Dexamethasone suppression test
3. Inflammatory and immunological disorders
   - Osteoarthritis, UC/CD’s, rhinitis, asthma, RA, MS, organ transplant

Question 2

What are adverse effects of corticosteroids?

Answer 2

Mood disturbances, insomnia, moon face, increased risk for infections, fat deposits on face and back of shoulders, osteoporosis, hyperglycemia, sodium/fluid retention, thin extremities, abdominal fat deposits, thin skin, purple striae, bruises, and petechiae, hypokalemia

Question 3

What are contraindications for corticosteroids?

Answer 3

Systemic infections (TB, herpes), diabetes, peptic ulcer, osteoporosis, HF and hypertension, cataracts and glucoma, pregnancy, and CNS disorders (psychosis)

Question 4

What are drug interactions with corticosteroids?

Answer 4

NSAIDs (GI irritation), diabetic agents, diuretics and digoxin (impact K+ levels), antihypertensive meds
Note: there are interactions with CYP inducers (phenytoin, phenobarbital) and CYP inhibitors (ritonavir, ketoconazole)
Note: Other interactions include live vaccines

Question 5

What are dosing considerations for corticosteroids?

Answer 5

Should be given first thing in the morning before 9am since the adrenal glands secrete most corticosteroids in the morning

Question 6

Which drug(s) are a weak glucocorticoid and mineralocorticoid?

Answer 6

Hydrocortisone and cortisone

Question 7

What drug is a potent glucocorticoid and mineralocorticoid?

Answer 7

Fludrocortisone

Question 8

What drug is a potent glucocorticoid and a weak mineralocorticoid?

Answer 8

Prednisone and methylprednisone

Question 9

What drugs are potent glucocorticoids with no mineralocorticoid effect?

Answer 9

Triamcinolone, betamethasone, and dexamethasone

Question 10

What are parental glucocorticoids and when are they mainly used for?

Answer 10

Drugs: hydrocortisone, methylprednisolone, triamcinolone, betamethasone, and dexamethasone
Main use: emergencies aka acute adrenal crisis
Agent of choice: Hydrocortisone because it has GC and MC activity

Question 11

What are oral glucocorticoids and what are they mainly used for?

Answer 11

Drugs: hydrocortisone, prednisone, methylprednisone, dexamethasone
Clinical uses: adrenal insufficiency, inflammatory/autoimmune, solid organ transplant, chemotherapy (lymphoid)

Question 12

What drug is an inhaled glucocorticoid and what is it used for?

Answer 12

Drug: triamcinolone
Clinical use: asthma, allergic/non-allergic rhinitis, COPD

Question 13

What are topical glucocorticoids and what are they used for?

Answer 13

Drugs: hydrocortisone, triamcinolone, betamethasone, dexamethasone
Note: these are safest for chronic application
Clinical use: inflammatory dermatoses

Question 14

Fludrocortisone characteristics

Answer 14

Clinical use: adrenal insufficiency (addison’s)
MOA: potent mineralocoritcoid
Adverse effects: salt and fluid retention, hypertension, heart failure

Question 15

Spironolactone

Answer 15

Clinical use: primary hyperaldosteronism, hypokalemia, and heart failure
MOA: antagonist at the MC receptor