Glucocorticoids Flashcards
steroids effect on blood cells?
neutrophilia
the rest decreased
with greatest anti-inflammatory activity, long-acting
betamethasone, dexamethasone
fluorinated derivatives
anaphylaxis steroid of choice
hydrocortisone - fast-acting!
can also inc blood volume (bc greater mineralocorticoid activity), preventing shock!!
brain tumor, cerebral edema steroid of choice
betamethasone, dexamethasone - low mineralocorticoid
*methylprednisolone for pulmo
what time of day to give steroids
NOT at night
*give short-acting -> high dose in the morning, low dose in the afternoon
glucocorticoid receptors have highest affinity for
dexamethasone
accounts for the more rapid effects (and more short lived)
what exactly does it affect?
non-genomic effects
post-translational modification of inflammatory proteins
3 major mechanisms for anti-inflammatory, immunosuppressive, and anti-allergic effects of cs
interference with LEUKOCYTE migration and fxn
inhibition of ARACHIDONIC ACID cascade (synthesis of PG, leukotrienes)
permissive effect on CATECHOLAMINE activity: VASOCONSTRICTION to minimize swelling
why will you become prone to infection with chronic use of steroids?
interference w phagocytosis
decreased antibody formation (and allergic reactions)
effect on t and b cells
t cell apoptosis
b cells less affected
Th1 & Th2 derived cytokines
Th1: IL2, IL3, TNFa, IFNy
Th2: IL4, 5, 6, 13
on vaccination: cs ok for (2), but not for
ok for pneumococcal and influenza vaccines
not for live vaccines (bc immunosuppressed ka)
low dose
5mg prednisone??
moderate
<2mg/kg pred
high
>=2mg/kg pred
high dose -> delay vaccination 2 wks
:)
inhaled and topical cs risk for systemic infections?
none
inhaled - only risk is oropharyngeal candidiasis - so GARGLE AFTER USE
infections
taking low dose
moderate to high dose
reactivation of
low - herpes zoster!
mod to high - tb!
strongyloides; other helminthic/protozoan infections
