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Dermatology > Glucocorticoids > Flashcards

Glucocorticoids Flashcards

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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
Q

Why does Vetalong (Triamcinolone acetonide) and Depo-Medrol last a long time in the tissue

A

because they are suspensions of insoluble esters
-Acetate, Privalate, Acetonide

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26
Q

What makes steroids short-acting

A

because they are suspension of water soluble (salt, phosphate) esters

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27
Q

Why is dexamethasone a short-acting steroid

A

becuae it is water soluble (salt, phosphate) esters

lasts 1-3 days (dose-dependent)

giving this injectables orally changes bioavailability and duration

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28
Q

How do you rank the steroids based on relative potency

A

1) Hydrocortisone
2) Prednisone
3) Dexamethasone
4) Betamethasone, Mometasone, Triamcinolone
5) Fluocinolone

29
Q

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

A

Hydrocortisone aceponate

30
Q

topical corticosteroids can be used as effectively as systemics for

A

focal inflammatory lesions

31
Q

Even a single dose of topical or systemic steroids will

A

Suppress the HPA acis (dose/formulation dependent)

32
Q

With systemic steroids, longer tx duration, the greater

A

wash-out
-4-8 weeks for many protocols (dexamethasone)
-Cutaneous changes due to steroids can take months to resolved

33
Q

The wash-out of topical steroids depends on

A

the formulation
-Mometasone, hydrocortisone aceponate less effect

can get systemic signs with topical absorption (patient dependent)

34
Q

T/F: we can get systemic signs with topical steroid absorption

A

True

35
Q

Steroids affects the skin and fur long-term. What changes are seen

A

-Hair loss
-Increased susceptibility to infection
-Thinning of skin
-Calcinosis cutis

36
Q

How do steroids affect muscle

A

-Weakness (short-term)
-Pendulous abdomen (long term)
-Thinning (long term)
-Temporal muscle atrophy (long term)

37
Q

What does steroids affect the CNS short term

A

Polydipsia
Polyphagia
Mood change/aggression

38
Q

How do steroids affect the kidneys

A

Polyuria
Protein-losing glomerulonephropathy
Altered electrolyte balance

39
Q

What are the cutaneous adverse effects of steroids due to catabolism + immunosuppression

A

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
Q

What parasite is likely to overgrow with steroid usage, caused comedones

A

Demodex

41
Q

What systemic effects are seen with steroids

A

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
Q

How can steroids lead to gastric ulceration

A

inhibits protective prostaglandins

43
Q

What can steroids cause in horses

A

Laminitis

Triamcinolone > Dexamethasone > Prednisolone

44
Q

How can steroids cause diabetes mellitus

A

decreased insulin response, increased gluconeogenesis - PEPCK enzyme

45
Q

How can steroids cause heart failure and/or hypertension

A

increased circulatory volume

46
Q

a type of skin scarring that appear as irregular bands, lines, or stripes

can occur secondary to steroids

A

striae

47
Q

dermal calcium deposition that is secondary to steroids or cushings
leads to inflammatory response

A

calcinosis cutis

48
Q

If hairs are in telogen due to steroids there will be

A

No growth phase

49
Q

What changes to the cat’s ears can be seen with steroids

A

pinnal laxity

(topical or oral)

50
Q

What CBC changes is seen with steroids

A

1) Neutrophilia
decreased extravasation from circulation
2) Monocytosis
decreased extravasation from circulation
3) Lymphopenia (immunosuppression)
4) Thrombocytosis (hypercoagulopathy, increased productio)

“Stress leukogram”

51
Q

What CHEM changes are seen with steroids

A

1) Hyperglycemia (decreased insulin response)
2) Steroid hepatopathy (increased ALP, ALT, GGT) - largely induced and expected
3) Decreased thyroid hormone (FT4 less affected)

52
Q

What UA changes are seen with steroids

A

1) Isosthenuria / Hyposthenuria
2) Occult UTI- things are harder to find when theyre dilutes

53
Q

T/F: routine anti-inflammatory doses do not appear to impede a protective response to vaccination

A

True

54
Q

Steroid hepatopathy, what induced liver enzyme elevations are expected

A

ALP, ALT, GGT

ALP > ALT

55
Q

In a dog on steroids with an elevated BUN and normal Creatinine, what are you suspicious for

A

Gastric ulceration? GI bleed?

56
Q

What is the physiologic dose of prednisolone for a dog/horse

A

0.2-0.3 mg/kg/day

57
Q

What is the anti-inflammatory (anti-pruritic) dose of prednisolone for a dog/horse

A

0.5-1 mg/kg/day

58
Q

What is the immunomodulatory dose of prednisolone for a dog/horse

A

2 mg/kg/day

59
Q

What is the physiologic dose of prednisolone for a cat

A

0.5 mg/kg/day

60
Q

What is the anti-inflammatory dose of prednisolone for a cat

A

1-2 mg/kg/day

61
Q

What is the immunomodulatory dose of prednisolone for a cat

A

3+ mg/kg/day

62
Q

How often should you dose prednisolone

A

total daily dose can be separated out (a24 hours, BID)

63
Q

How do you dose Triamcinolone / Dexamethasone

A

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
Q

Cats typically have _________ the steroid dose as dogs do

A

twice

65
Q

With steroids most dermatological diseases can be in remission in

A

1-2 weeks and then taper to effect

hit them hard and then get out

“lowest effective dose’ is paramount

66
Q

What is up with steroid maintenance

A

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
Q

What are common pitfalls with steroid tapering

A

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 <two weeks)
-Adrenal hibernation is not instaneous
-Long term (months) requires tapering for at least 4 weeks

68
Q
A

Dermatology (10 decks)

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