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Dermatology > Glucocorticoids > Flashcards

Glucocorticoids Flashcards

1
Q

Why do steroids have global effects on the body

A

they get in most cells through the cell membrane and act/suppress the nucleus

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2
Q

Once steroids get into the cell and cause nuclear transcription/repression of glucocorticoid-sensitive genes, what does protein synthesis of Annexin A1 do?

A

It affects neutrophils
1) Increased L-selectin shedding
2) Decrease endothelial adherence
3) Decrease endothelial tranigration

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3
Q

What does Annexin A1 do

A

It affects neutrophils
1) Increased L-selectin shedding
2) Decrease endothelial adherence
3) Decrease endothelial tranigration

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4
Q

If steroids supress cell lines, why do you see an increase in neutrophils

A

Neutrophilia from decreased extravasation

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5
Q

How do steroids affect macrophages

A

inhibit phagocytosis, cytokine release (IL-1, IL-2, TNFa)

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6
Q

How do steroids affect b-cells

A

decrease antibody production

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7
Q

How do steroids affect fibrogenesis

A

decrease

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8
Q

How do steroids affect the arachidonic acid cascade

A

reduced prostaglandin/keukotriens

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9
Q

With steroids, how are t-cells inhibited

A

IL-2 inhibition

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10
Q

T/F: steroids do pain control

A

true

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11
Q

Are steroids good for acute or chronic management

A

acute

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12
Q

What are examples of short-acting steroids

A

cortisone
hydrocortisone

about 8-12 hours

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13
Q

What are examples of intermediate-acting steroids

A

Prednisone
Prednisolone
Methylpredisolone

all are about 12-36h

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14
Q

What steroids is less likely to cause PU/PD because it has no mineralocorticoid potency

A

Methylprednisolone

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15
Q

Do cats tolerate prednisone or prednisolone better

A

Prednisolone

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16
Q

What are the long acting steroids

A

Triamcinolone
Flumethasone
Dexamethasone
Betamethasone

all about 35-54 hours (expect trimcinolone 12-36)

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17
Q

What are the steroids with mineralocorticoid potency

A

Hydrocortisone (2)
Prednisone (1)
Prednisolone (1)

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18
Q

What is the preferred route for steroid dosing

A

Oral*

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19
Q

The onset of effect of systemic corticoisteroids is often delayed for ________, regardless of the route of administration

A

3-8 hours

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20
Q

T/F: IV is the fastest method of steroid absorption

A

True

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21
Q

T/F: IM is faster at absorbing steroids than oral

A

False

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22
Q

rapidly diminishing response to a drug

A

Tachyphlyaxis

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23
Q

What are the potency factors of steroids

A

1) Polarity (aqeuous vs lipophilic)
2) Protein binding
3) Liver metabolism (prednisone to prednisolone)
4) Cellular metabolism
5) Receptor affinity

Potency changes with species, tissue, patient, and application method

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24
Q

What steroids are insoluble esters that stay in the tissue a long time

A

1) Vetalog (triamcinolone acetonide) - last about a week SQ/IM
2) Depo-Medrol (methylprednisolone acetate) - lasts 3-12 weeks (SQ/IM)

bad because you cant take it out if something goes wrong

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25
Why does Vetalong (Triamcinolone acetonide) and Depo-Medrol last a long time in the tissue
because they are suspensions of insoluble esters -Acetate, Privalate, Acetonide
26
What makes steroids short-acting
because they are suspension of water soluble (salt, phosphate) esters
27
Why is dexamethasone a short-acting steroid
becuae it is water soluble (salt, phosphate) esters lasts 1-3 days (dose-dependent) giving this injectables orally changes bioavailability and duration
28
How do you rank the steroids based on relative potency
1) Hydrocortisone 2) Prednisone 3) Dexamethasone 4) Betamethasone, Mometasone, Triamcinolone 5) Fluocinolone
29
a potent new generation glucocorticoid thats double esterificiation of HCA makes it ideal 30x more potent than hydrocortisone Lipophilic for skin penetration Locally metabolized dermal metabolism
Hydrocortisone aceponate
30
topical corticosteroids can be used as effectively as systemics for
focal inflammatory lesions
31
Even a single dose of topical or systemic steroids will
Suppress the HPA acis (dose/formulation dependent)
32
With systemic steroids, longer tx duration, the greater
wash-out -4-8 weeks for many protocols (dexamethasone) -Cutaneous changes due to steroids can take months to resolved
33
The wash-out of topical steroids depends on
the formulation -Mometasone, hydrocortisone aceponate less effect can get systemic signs with topical absorption (patient dependent)
34
T/F: we can get systemic signs with topical steroid absorption
True
35
Steroids affects the skin and fur long-term. What changes are seen
-Hair loss -Increased susceptibility to infection -Thinning of skin -Calcinosis cutis
36
How do steroids affect muscle
-Weakness (short-term) -Pendulous abdomen (long term) -Thinning (long term) -Temporal muscle atrophy (long term)
37
What does steroids affect the CNS short term
Polydipsia Polyphagia Mood change/aggression
38
How do steroids affect the kidneys
Polyuria Protein-losing glomerulonephropathy Altered electrolyte balance
39
What are the cutaneous adverse effects of steroids due to catabolism + immunosuppression
1) Scale (weeks to months)- common 2) Truncal alopecia- months; common 3) Demodex overgrowth- any point, uncommon 4) Comedones- weeks to months, uncommon (check for Demodex) 5) Calcinosis cutis- months, uncommon 6) Hyperfragility syndrome (cats)- months, rare 7) Opportinistic infections- depends on tissue location/infection 8) Curling ear tips (cartilage)- cat; rare 9) Delayed wound healing - days to weeks, common
40
What parasite is likely to overgrow with steroid usage, caused comedones
Demodex
41
What systemic effects are seen with steroids
1) PU/PD -ADH deficiency? 2) Polyphagia (days) 3) Food aggression - days to weeks 4) Insomnia (humans) 5) Weight gain (polyphagia) 6) Gastric ulceration-inhibits prostaglandins 7) Ligament rupture (catabolism) 8) Laminitis in horses 9) Diabetes mellitus (decreased insulin response) 10) Heart failure (increased circulatory volume) 11) Hypertension (increased circulatory volume)
42
How can steroids lead to gastric ulceration
inhibits protective prostaglandins
43
What can steroids cause in horses
Laminitis Triamcinolone > Dexamethasone > Prednisolone
44
How can steroids cause diabetes mellitus
decreased insulin response, increased gluconeogenesis - PEPCK enzyme
45
How can steroids cause heart failure and/or hypertension
increased circulatory volume
46
a type of skin scarring that appear as irregular bands, lines, or stripes can occur secondary to steroids
striae
47
dermal calcium deposition that is secondary to steroids or cushings leads to inflammatory response
calcinosis cutis
48
If hairs are in telogen due to steroids there will be
No growth phase
49
What changes to the cat's ears can be seen with steroids
pinnal laxity (topical or oral)
50
What CBC changes is seen with steroids
1) Neutrophilia decreased extravasation from circulation 2) Monocytosis decreased extravasation from circulation 3) Lymphopenia (immunosuppression) 4) Thrombocytosis (hypercoagulopathy, increased productio) "Stress leukogram"
51
What CHEM changes are seen with steroids
1) Hyperglycemia (decreased insulin response) 2) Steroid hepatopathy (increased ALP, ALT, GGT) - largely induced and expected 3) Decreased thyroid hormone (FT4 less affected)
52
What UA changes are seen with steroids
1) Isosthenuria / Hyposthenuria 2) Occult UTI- things are harder to find when theyre dilutes
53
T/F: routine anti-inflammatory doses do not appear to impede a protective response to vaccination
True
54
Steroid hepatopathy, what induced liver enzyme elevations are expected
ALP, ALT, GGT ALP > ALT
55
In a dog on steroids with an elevated BUN and normal Creatinine, what are you suspicious for
Gastric ulceration? GI bleed?
56
What is the physiologic dose of prednisolone for a dog/horse
0.2-0.3 mg/kg/day
57
What is the anti-inflammatory (anti-pruritic) dose of prednisolone for a dog/horse
0.5-1 mg/kg/day
58
What is the immunomodulatory dose of prednisolone for a dog/horse
2 mg/kg/day
59
What is the physiologic dose of prednisolone for a cat
0.5 mg/kg/day
60
What is the anti-inflammatory dose of prednisolone for a cat
1-2 mg/kg/day
61
What is the immunomodulatory dose of prednisolone for a cat
3+ mg/kg/day
62
How often should you dose prednisolone
total daily dose can be separated out (a24 hours, BID)
63
How do you dose Triamcinolone / Dexamethasone
it is about 7-10x as potent as prednisolone assume 10x and move the decimal point Ex: Immunomodulatory for dog would be 0.2mg/kg
64
Cats typically have _________ the steroid dose as dogs do
twice
65
With steroids most dermatological diseases can be in remission in
1-2 weeks and then taper to effect hit them hard and then get out "lowest effective dose' is paramount
66
What is up with steroid maintenance
long-term disease control is not necessarily 100% disease resolution- it is about quality of life/management Goal is physiologic dose EOD if you cant get there: Azathioprine, Cyclosporine, Chlorambucil, Mycophenolate, Leflunomide, Topical Tacrolimus
67
What are common pitfalls with steroid tapering
1) Using injectables- still take hours, even parenterally, not necessarily more efficacious, overdose can lead to adverse side effections 2) x for 3d, x for 3d, x for 1.5 days you dont give it a chance to work 3) Not tapering fast enough- steroid adverse effects are progressively dose and time dependent -Serious infection of adverse eent (gastric ulcer, calcinosis cutis) might necessitate a significant decrease in a short period of time -Depends on duration and dose but short term steroids can be tapered within 1-2 weeks (or not at all if
68

Dermatology (10 decks)

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