Glucocorticoids/Anti-Inflammatory Agents

Question 1

glucocorticoid drugs target the same receptor as endogenous cortisol, which is

Answer 1

GC-R

Question 2

activation of GC-R receptor

is necessary for __

Answer 2

anti-inflammatory actions

Question 3

what receptor is responsible for ADRs of glucocorticoids

Answer 3

GC-R

same as anti inflammatory

Question 4

short to med acting glucocorticoids

Answer 4

hydrocortisone (cortisol)

prednisone

methylprednisone

Question 5

intermediate-acting glucocorticoid to know

Answer 5

triamcinolone

Question 6

long-acting glucocorticoid to know

Answer 6

dexamethasone

Question 7

which 2 glucocorticoids have no topical use

Answer 7

cortisone

prednisone

Question 8

major regulator of aldosterone synthesis

Answer 8

angiotensin II

Question 9

effect of GC on the adrenal gland

Answer 9

suppression

Question 10

t/f: endogenous AND exogenous GC also suppress ACTH release

Answer 10

T!

Question 11

chronic use of pharmacologic doses of GCs can suppress __,

which leads to no ACTH and __

Answer 11

HPA axis

adrenal hypertrophy

Question 12

if the adrenal gland is suppressed, the patient is reliant on

Answer 12

exogenous GCs

Question 13

insufficient adrenal response to environmental stressors is called

Answer 13

adrenal crisis

Question 14

tx for adrenal crisis

Answer 14

exogenous GCs

Question 15

t/f: pharmacologic doses of GCs can cause iatrogenic Cushing’s

Answer 15

T!

Question 16

excess GC use causes (7)

Answer 16

hyperglycemia

muscle wasting

central obesity

insomnia/dpn/euphoria

OP

ulcers

iatrogenic hyperaldosteronism → fluid retention, hypokalemia, metabolic alkalosis

Question 17

bad AI/IS effects of GCs (3)

Answer 17

decrease healing

diminish immunoprotection

Question 18

clinical value of GCs

Answer 18

suppress chronic inflammation

suppress AI rxns

Question 19

GCs inhibit synthesis of both

Answer 19

PGs (prostaglandins)

LTs (leukotrienes)

Question 20

which to GCs require activation in the liver

Answer 20

prednisone → prednisolone

cortisone → hydrocortisone

Question 21

which form of GCs are inactive

Answer 21

11-keto

Question 22

which functional group is required for activation of GCs

Answer 22

OH → hydroxyl

Question 23

mc used oral GC used for steroid burst therapy

Answer 23

prednisone

Question 24

which steroid has minimal MC action

Answer 24

methylprednisone

dexamethasone

Question 25

IV form of methylprednisolone

Answer 25

solu-medrol

Question 26

oral form of methylprednisolone

Answer 26

medrol

Question 27

clinical use of cortisol (hydrocortisone)

Answer 27

replacement therapy → emergencies

Question 28

how is cortisol administered (2)

Answer 28

oral parenteral

Question 29

which GC has no topical activity

Answer 29

prednisone *needs to be converted in the liver*

Question 30

most potent GC

Answer 30

dexamethasone (Decadron)

Question 31

uses of dexamethasome

Answer 31

cerebral edema chemo-induced vomiting

Question 32

which GC has greatest suppression of ACTH secretion at pituitary

Answer 32

dexamethasone (decadron)

Question 33

which GC has excellent systemic AND topical activity, but no MC action

Answer 33

triamcinolone

Question 34

non-adrenal collagen-vascular disorder to know

Answer 34

RA

Question 35

order of tx for RA (4)

Answer 35

1. NSAIDs 2. GCs as bridge 3. MTX (DMARD) 4. Etanercept and Infliximab

Question 36

when are DMARDs added to RA tx

Answer 36

when dx is certain → suppress dz progression

Question 37

how are GCs used for RA (2)

Answer 37

as a bridge until DMARDs take effect adjunctive when dz persists

Question 38

\_\_ side effects vary w. agent but __ side effects are unavoidable

Answer 38

MC GC

Question 39

list GC agents in order of least to most MC effect

Answer 39

cortisol prednisone methylprednisone/dexamethasone

Question 40

how is dosage figured out w. GC

Answer 40

trial and error → re-evaluation

Question 41

when should you reduce dose of GC

Answer 41

as soon as therapeutic dosages are obtained

Question 42

if a larger initial dose is needed, what GC should you choose

Answer 42

one w. little MC action

Question 43

how do you minimize adrenal suppression of GC

Answer 43

alternate day schedule

Question 44

how do you minimize dz rebound and adrenal crisis (insufficiency)

Answer 44

terminate gradually

Question 45

major consideration in deciding route of GC administration

Answer 45

minimize systemic actions

Question 46

routes of administration for GC (7)

Answer 46

oral topical ophthalmic intra-articular enemas inhalants nasal sprays

Question 47

mc rout of administration when systemic actions are desired

Answer 47

**oral** also IV/IM

Question 48

what 4 things can cause systemic effects of topical GCs

Answer 48

potent agent long term use occlusive dressings large area of application

Question 49

route of GC administration for OA/RA

Answer 49

intra-articular

Question 50

why would you use a GC enema

Answer 50

UC

Question 51

what determines adverse effects of GCs (2)

Answer 51

dose duration

Question 52

what s.e can you expect w. GC use \>2-4 weeks

Answer 52

iatrogenic Cushing's → DM like state HPA axis suppression mood disturbance increased infxn risk impaired wound healing/increased bruising OP cataracts skin atrophy/collagen loss growth retardation peptic ulcers moon facies

Question 53

which 2 GC cause the most HPA suppression

Answer 53

dexamethasone betamethasone *may also cause decrease in GH*

Question 54

what reduces peptic ulcer risk w. long term GC use

Answer 54

antacids

Question 55

what decreases risk of OP w. long term GC use

Answer 55

bisposphanates

Question 56

what s.e of GC are seen w. burst therapy

Answer 56

GI upset insomnia DPN HTN hyperglycemia