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Endocrinology > Glucocorticoids > Flashcards

Glucocorticoids Flashcards

1
Q

Glucocorticoids are a ______ group of ______. They are ________ mediators and have _______ effects

A

Specific - Steroids - Inflammatory - Metabolic

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2
Q

Why should glucocorticoids not be subscribed whilst investigation into a disease is ongoing?

A

They diminish efficacy of further investigtion by suppressing symptoms

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3
Q

Where do glucocorticoids act on a cellular level?

A

Intracellulary by acting on gene expression

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4
Q

What does tachyphylaxis of glucocorticoids mean?

A

They increase their own metabolism meaning that as the period of treatment increases the half life decreases - body gets better at metabolising the drug

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5
Q

Never prescribe a ____ dose of glucocorticoids for a ____ period of time

A

Low - Long

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6
Q

Name 4 effects of glucocorticoids on body systems

A

Immunomodification - Carbohydrate, lipid and protein metabolism pathways - Endocrine function - Pyschogenic effects

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7
Q

On the inflammatory pathway, where and on what do glucocorticoids act?

A

High up - Stop cell membrane phospholipids being changed into arachidonic acid (by phosphlipase A2)

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8
Q

What are the net anti-inflammatory effects of glucocorticoids?

A

Depress: Oedema - fibrin deposition - capillary dilation - leukocyte migration - phagocytic activity - capillary & fibroblast proliferation - collagen deposition

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9
Q

Glucocorticoids inhibit both ____ and _____ manifestations of inflammation

A

Early and late

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10
Q

What is the main difference between glucocorticoid anti-inflammatory action and NSAIDs?

A

Glucocorticoids suppress T-lymphocyte function, inhibit monocyte-macrophage activities, suppress fibroblast function, reduce histamine from mast cells and decrease synthesis of lymphokines

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11
Q

Chronic administration of glucocorticoids will cause _____ ______

A

Immune suppression

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12
Q

Which glucocorticoids are short acting? (<12 hours)

A

Cortisone - Hydrocortisone

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13
Q

Which glucocorticoids are intermediate acting? (48 hours)

A

Prednisone - Prednisilone - Methylprednisilone - Triamcinolone

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14
Q

Which glucocorticoids are long acting? (>48 hours)

A

Flumethasone - Dexamethasone - Betamethasone

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15
Q

What three factors of a glucocorticoid affect the duration of action?

A

Half-life - Ester’s solubility in formulation - Dose of drug

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16
Q

Name two esters that are very soluble

A

Succinate - Phosphate

17
Q

Name a soluble ester

A

Polyethylene glycol

18
Q

Name three moderately insoluble esters

A

Acetate - Phenylproprionate - Isoincotinate

19
Q

Name a poorly soluble ester

A

Acetonide

20
Q

How does an ester alter the time of action of a glucocorticoid?

A

Determines the solubility so if it very soluble the glucocorticoid will be released in minutes, if the ester is very insoluble the glucocorticoid will be released over a matter of weeks

21
Q

What are inhaled glucocorticoids used for? Give some examples

A

Immune-mediated bronchial inflammation - Fluticasone proprionate, Beclomethasome diproprionate, Budesonide, Flunisolide, Triamcinolone acetonide

22
Q

Why are glucocorticoids such as Fluticasone proprionate used for inhaled glucocorticoids?

A

Increased glucocorticoid receptor affinity particularly in the respiratory tract - Less systematic side effects

23
Q

When treating immune-mediated disease what are the two phases when using glucocorticoids? Explain the difference

A

Induction of remission - Maintenance of remission
Induction centred around high dose once daily glucocorticoid - Remission centred around alternate day therapy with synergistic immunosupressant

24
Q

What glucocorticoid is almost always used in immune-mediated disease treatment?

A

Prednisone or prednisolone

25
Q

What sort of dose of glucocorticoids do cats need in relation to dogs? Why?

A

Higher - They are considered more steroid resistant

26
Q

Are gastroprotectants useful during glucocorticoid therapy?

A

No - no downside but no upside either

27
Q

What are the adverse effects of glucocorticoids?

A

PD/PU (dogs) - Polyphagia (overeating)

28
Q

Why is under-treatment with glucocorticoids bad?

A

Can cause as many if not more problems for a patient that is over-treated

Endocrinology (7 decks)

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