Glucocorticosteroids Flashcards
Glucocorticosteroids, mineralocorticoids, and sex hormones precursors are all what?
Adrenocortical hormones (steroid molecules produced + released by adrenal cortex)
Functions of this drug include carbohydrate/lipid/protein metabolism, cardiovascular fx, and immune fx/inflammation.
Glucocorticosteroids
Which glucocorticosteroid has the greatest effect?
Hydrocortisone (b/c its just the exogenous form of cortisol, exactly the same structure)
What are the short acting glucocorticosteroids?
- Hydrocortisone (cortisol)
- Cortisone
- Fludrocortisone (mineralocorticoid)
What are the intermediate acting glucocorticosteroids?
- Methylprednisolone
- Prednisone
- Triamcinolone
What are the long acting glucocorticosteroids?
- Betamethasone
- Dexamethasone
How do glucocorticoids work?
Anti-inflammatory/immunosuppressive but also cause leukocytosis (increase WBC count) 2/2 demargination
What causes these effects: carb/lipid/protein metabolism, stimulate gluconeogenesis, promotes glucose formation, anti-insulin effect, decrease glucose uptake by cells, increase lipolysis/protein lysis, decrease protein synthesis?
Glucocorticosteroids
What effects do glucocorticosteroids have on bone?
- Decrease Ca absorption from intestine
- Increase mobilization of Ca from bone
- Increase risk of osteoporosis - recommend Ca (1000-1200 mg/day) + VD (800-2000 IU/day)
What effects do glucocorticosteroids have on peptic ulceration?
- Increase gastric output
- Decrease synthesis of mucopolysaccharides (glycosaminoglycans)
- Increase risk w/ NSAID use, total doses > 1 gm Prednisone + > 30 day DOT
What CNS effects do glucocorticosteroids have?
- Euphoria, insomnia, psychosis -> Depression
- Magnify existing conditions
- Steroid psychosis
What effects do glucocorticosteroids have on edema + HT?
Na + H2O retention (mineralocorticoids)
- Moon face (Cushings)
- Buffalo hump (due to fat redistribution)
What effects do glucocorticosteroids have on growth?
Suppression in children due to HPA inhibition
Cataract formation, glaucoma, increase in hair growth, weight gain, acne…are all what?
Adverse effects of glucocorticoids
What are monitoring parameters for use of glucocorticosteroids?
- Complete blood counts
- Electrolytes
- Plasma glucose
- Lipid panels
- Bone scan
- Monitor pts for Na retention, edema + HT
- Monitor pt peptic ulcer disease, osteoporosis + hidden infx
What are inhaled steroids used for?
Asthma + COPD
- must rinse mouth after using to prevent candida (thrush)
What are intranasal steroids used for?
Allergic rhinitis, non-allergic rhinitis, nasal polyps
What are opthalmic steroids used for?
Post-op inflammation, conjunctivitis, corneal injuries
What are rectal steroids used for?
Hemorrhoids + ulcerative colitis
What are shampoo steroids used for?
Seborrheic dermatitis (Fluocinolone)
Betamethasone, Budesonide, Cortisone acetate, Dexamethasone, Hydrocortisone, Methylprednisolone, Prednisolone, Prednisone, and Triamcinolone are all what?
Glucocorticosteroids that can be given systemically (PO or paraenterally)
What are the high potency topical steroids?
Amcinonide 0.1%
Betamethasone diprop, augmented 0.05% cream
Betamethasone valerate 0.1% oint
Desoximetasone 0.05% gel, 0.25% cream, oint
Fluocinodine 0.05%
Halcinonide 0.1%
Triamcinolone acetonide 0.5%
What can high potency topical steroids induce?
Majocchi granuloma (deep tissue tinea infx)
What are the very high potency topical lotions?
Betamethasone diprop augmented 0.05% oint
Clobetasol propionnate 0.05%
Diflorasone diacetate 0.05%
Halobetasol propionate 0.05%
What is the max amount of time a very high potency topical steroid should be used?
3 wks
How is potency of topical steroids determined?
Extent to which agent causes cutaneous vasoconstriction “blanching effect”
What should be used for tx of skin diseases characterized by inflamm, hyperproliferation, and/or immunologic phenomenon, and also burns + pruritus (i.e. allergic contact dermatitis, eczema, psoriasis)?
Topical steroids
What is important to consider before tx w/ steroids?
Get an accurate dx by skin scraping/potassium hydroxide tests (tells you steroid vs. antifungal; steroids can exacerbate a fungal infx)
What is the most common SE of topical steroids?
Atropy of epidermis/dermis
Acneiform eruption, folliculitis, rosacea, atrophy, skin fragility delayed wound healing, purpura, erythema, hypopigmentation, masking/aggravation of dermatophyte infx, secondary infx or aggravation of exisiting infx, and contact dermatitis are all what?
ADR for topical steroids
Which preparation of topical steroids is used for treating dry/thick, hyper-keratotic lesions, provides good occlusion (which improves absorption), and should not be used on hairy/intertriginous areas (may cause maceration/folliculitis)?
Ointment
Which preparation of topical steroids is useful for acute exudative inflamm (b/c drying effect), can be used on intertriginous areas (groin, gluteal cleft, axilla), has good lubrication, is cosmetically appealing, may contain preservatives (irritation, stinging + allergic rxn), and is less potent than ointments?
Creams
Which preparation of topical steroids is the least greasy/occlusive, may contain alcohol (drying effect on oozing lesion), is useful for hairy areas, and is beneficial for exudative inflamm (poison ivy)?
Lotions -> contain alcohol
Gels -> poison ivy
Which is the most expensive preparation out of the 3 topical steroids: foams, mousses, shampoos?
Foams
