Glucocorticoids Flashcards
What is the pharmacologic uses of glucocorticoids?
Rheumatoid arthritis, systemic, lupus, IBS, inflammatory disorders, allergies, asthma, dermatologic disorders, suppression of allograft, rejection, neoplasm, respiratory distress syndrome
What adrenal disease are glucocorticoids used for diagnosing?
Cushing syndrome
What are the three hormones that the adrenal cortex secretes?
Cortisol, aldosterone, and androgen
What system regulates the secretion of adrenal hormones
Hypothalamus pituitary adrenal axis
What can cause HPA axis suppression
Long-term corticosteroid therapy
After how long does suppression of the HPA system happen while on corticosteroids
About one month
How long does it take to recover from HPA suppression
Up to 12 months
Which class of glucocorticoids are absorbed more slowly
Acetates
Since glucocorticoids are highly protein bound, what can affect the distribution of the drugs?
Hyperproteinemia pregnancy or low serum protein in the elderly
How are glucocorticoids classified?
By their onset and duration of action
What glucocorticoids are low potency short acting and used for adrenal insufficiency or weak anti-inflammatory agents
Cortisol and hydrocortisone
What glucocorticoids have medium potency are intermediate acting and used for systemic treatment and cancer inflammation all allergies and autoimmune disorders?
Prednisone, prednisone, methylprednisolone, and triamcinolone
What glucocorticoids are high potency and long acting
Dexamethasone and bethametasone
In general, what should the rule of prescribing glucocorticoids be?
Prescribed the smallest effective dose for the least amount of time
For patients who have been on long-term therapy with a glucocorticoid and are now discontinuing, the drug gradual taping of the drug is needed to allow recovery because:
The hypothalamic pituitary adrenal system
How do glucocorticoids work?
They suppress the production of prostaglandins which suppresses inflammation and decreases the amount of inflammation caused by damage
Pharmacologic effects of exogenous glucocorticoids include what
Inhibition of prostaglandins
What do glucocorticoid stimulate to increase blood sugar?
Gluconeogenesis
Why do glucocorticoids place patients at risk for osteoporosis?
Long-term use of glucocorticoids release amino acids from proteins in a skeletal muscle, including the protein matrix of the bone, so long-term therapy will lead to osteoporosis
What are the metabolic effects of glucocorticoids?
Raise blood sugar insulin resistance, hirsutism, increase in insulin production
What are the catabolic effects of glucocorticoids?
Increase protein breakdown, increased bone and connective, tissue, fat and skin wasting these can lead to osteoporosis or growth inhibition in children
What syndrome is an adverse effect of high dose steroid therapy?
Cushing syndrome
How do glucocorticoids contribute to steady state regulation of hematopoiesis?
They increase the total leukocyte count due to accelerating their release from the bone marrow
What physiologic cardiovascular effects to glucocorticoids have
Increase in red blood cells and leukocytes which leads to neutrophilia
What indirect cardiovascular effects does glucocorticoids have?
Stimulate lipolysis and lipogenesis increase risk of cardiovascular disease ASHD and heart failure and increased risk for TIA stroke and VTE
At what dose level of prednisone are you at risk for a stroke?
7.5 mg a day
What renal effects do glucocorticoids have?
Retention of sodium and water leading to hypernatremia and edema and hypertension and increased urinary excretion of potassium leading to hypokalemia
Rapid administration of high doses of Gluccocorticoids can lead to what
Hypokalemia and metabolic alkalosis
What effect can glucocorticoids have on the respiratory system?
They can facilitate long maturity and neonates and prevent RDS
What CNS affects can glucocorticoids have
They can induce psychiatric and cognitive symptoms, mania, hypomania, psychosis, depression, delirium, and sleep disruption
What CNS conditions can glucocorticoids treat?
Multiple sclerosis, CNS trauma space occupying brain lesions, acute optic neuritis cerebral edema
What G.I. condition can glucocorticoids treat
Inflammatory bowel disease
What G.I. symptoms can glucocorticoids cause
Increased risk of gastritis, ulcer formation, G.I. bleeds especially in use with in NSAIDs
How can you prevent G.I. issues in glucocorticoids?
Use a Gastro protective agent such as PPI or cytotec
What immune conditions can glucocorticoids be used to treat?
Rheumatoid arthritis, psoriasis, eczema
What form of glucocorticoids are not associated with immunosuppressive effects?
Inhaled and topical forms
When is suppression assumed with treatment of prednisone?
Greater than 20 mg of prednisone per day for three weeks or Cushing features
What toxic effects of long-term administration of glucocorticoids happen
osteoporosis
