GLUCOCORTICOIDS & MINERALOCORTICOIDS

Question 1

the principal human glucocorticosteroid is…

Answer 1

…CORTISOL!!

little important fact about cortisol for you:
diurnal production = peak in the early morning → decline → smaller peak in the late afternoon

Question 2

SHORT-acting glucocorticoids: (1-12h)

Answer 2

1. hydrocortisone (1:1)
2. cortisone (0,8:0,8)

(anti-inflammatory effect:salt-retaining effect)

Question 3

INTERMEDIATE-acting glucocorticoids: (12-36h)

Answer 3

1. prednisone (4:0,8)
2. prednisolone (5:0,8)
3. methylprednisolone (5:0,5)
4. triamcinolone (5:0)

(anti-inflammatory effect:salt-retaining effect)

Question 4

LONG-acting glucocorticoids: (36-55h)

Answer 4

1. betamethasone (35:0)
2. dexamethasone (30:0)

(anti-inflammatory effect:salt-retaining effect)

Question 5

INHALED glucocorticoids:

Answer 5

1. beclomethasone
2. budesonide
3. fluticasone (lowest bioavailability)
4. flunisolide
5. triamcinolone
6. mometasone
7. ciclesonide (reduced risk of systemic effects, activated in airways)

Question 6

CONTRAindications → in SHORT-term treatment:

Answer 6

management of severe, ACUTE states (life threatening) even when high doses of glucocorticoids are administered → benefits usually outweigh the potential side effects of corticoids

Question 7

CONTRAindications → in LONG-term treatment:

Answer 7

1. acute viral infections
2. active, chronic hepatitis HBsAg+
3. parasitic diseases

Question 8

CONTRAindications → special precautions:

Answer 8

1. peptic ulcer (IPP, PGE1, H2 blockers)
2. acute & chronic bacterial infections (antibiotics, treatment of tuberculosis)
3. mycotic infections (anti-mycotic treatment)
4. hypertension (antihypertensive drugs)
5. diabetes (diabetic control, insulin)
6. osteoporosis (administration of Ca, vitamins)
7. psychiatric disturbances (psychiatric control & treatment)
8. glaucoma (ophthalmologic control & treatment)
9. growing children (alternate-day schedule or pulses)
10. hypoalbuminemia (adjustment of the given dose)

Question 9

side effects:

Answer 9

Cushing’s:

1. moon face
2. redistribution of fat tissue
3. hypertension
4. osteoporosis
5. impaired glucose tolerance
6. hyperlipidemia
7. impotence
8. thinning of skin
9. acne
10. Na+ retention
11. waste of K+
12. psychiatric disturbances, bizarre behaviour
13. increased susceptibility to infection
14. peptic ulcer (> 1000 mg; > 1 month)
15. increased risk of thrombi
16. atherosclerosis
17. delayed wound healing

exogenous glucocorticoids:

1. glaucoma
2. catharact
3. avascular necrosis of femoral head
4. pancreatitis

inhaled glucocorticoids:

1. mucosal atrophy 
2. fragility of vessels 
3. local infections

Question 10

MINERALOCORTICOIDS: (drug name)

Answer 10

1. fludrocortisone (10:125)

(anti-inflammatory effect:salt-retaining effect)

→ both glucocorticoid & very potent mineralocorticoid activity

Question 11

MINERALOCORTICOIDS → indication:

Answer 11

treatment of ADRENOCORTICAL INSUFFICIENCY