Inflammation Flashcards
1
Q
Systematic glucocorticoid
Common indications
A
- To allergic or inflammatory disorders e.g. anaphylaxis, asthma
- Suppression of autoimmune disease e.g. IBD, arthritis
- Treatment of some cancers as part of chemotherapy or to reduce tumour-associated swelling
- Hormone replacement in adrenal insufficiency or hypopituitarism
2
Q
Systematic glucocorticoid
MOA
A
- These corticosteroids exert mainly glucocorticoid effects
- They bind to cytosolic glucocorticoid receptors, which then translocate to the nucleus and bind to glucocorticoid-response elements, which regulate gene expression
- Corticosteroids are most commonly prescribed to modify the immune response
- They upregulate anti-inflammatory genes and downregulate pro-inflammatory genes (e.g. cytokines, TNF-a)
- Direct actions on inflammatory cells include suppression of circulating monocytes and eosinophils
- Their metabolic effect include increased gluconeogenesis from increased circulating amino and fatty acids, released by catabolism (breakdown) of muscle and fat
- These drugs also have mineralocorticoid effects stimulating Na + H20 retention and K excretion in the renal tubles
3
Q
Systemati glucocorticoid
Adverse effects
A
- Immunosuppression increases the risk and severity of infection and alters the host response
- Metabolic effects include: diabetes and osteoporosis
- Increased catabolism causes: proximal muscle weakness, skin thinning with easy bruising and gastritis
- Mood and behaviour changes include insomnia, confusion, psychosis and suicidal ideas
- HTN, Hypokalaemia and oedema resultant from mineralocorticoid action
- Steroids suppress HPA (ACTH secretion), switching off the stimulus for normal adrenal cortisol production
- In prolonged treatment, this causes adrenal atrophy, preventing endogenous cortisol secretion
- If corticosteroids are withdrawn suddenly this can cause addinsonian crisis and CV collapse may occur
- Symptoms of chronic glucocorticoid deficiency that occur during treatment withdrawal include fatigue, weight loss and arthralgia
4
Q
Systematic glucocortcoids
Warnings
A
- Corticosteroids should be prescribed with caution in people with infection and in children (suppress growth)
5
Q
Glucocorticoids
Interactions
A
- Steroids increase risk of peptic ulceration and GI bleeding when given with NSAIDs and enhance hypokalemia in patients taking B-agonist, theophylline, loop or thiazide diuretics
- Their efficacy may be reduced by CYP inducers (Phenytoin, CBZ, rifampicin)
- Steroids reduce the immune response to vaccines
6
Q
Steroids
Prescription
A
- Different steroids have different potencies
- In emergencies (tumour oedema), dex is prescribed at high doses (8mg BD), then weaned slowly
- Acute asthma, pred 40mg daily is given
- Where oral administration is inappropriate IV hydrocortisone can be given
- For the long term, the lowest possible dose of prednisolone should be given. May consider steroid-sparing agents (e.g. azathioprine, MTX)
- Also, consider bisphosphonates and PPI to reduce steroid effects
7
Q
Steroids
Communication
A
- Explain that treatment should suppress the underlying disease process and that the patient will usually start to feel better within 1-2 days
- For patients who require prolonged treatment, warn them to not stop treatment suddenly, as this could make them very unwell
- Give them a steroid card to carry around and show if they need treatment
- Discuss benefits and risks of steroids, including longer-term risks of osteoporosis, bone fractures and diabetes so that your patient can make an informed decision about taking treatment
8
Q
Steroids
Monitoring
A
- Monitoring efficacy will depend on the condition treated e.g. peak flow recordings for asthma, blood inflammatory markers for inflammatory arthritis
- In prolonged treatment, monitor for adverse effects by for example measuring glucose and HbA1c or performing a Dual-Energy X-ray Absorptiometry (DEXA)
9
Q
Topical steroids
Common indication
A
- Used in inflammatory skin conditions e.g. eczema to treat disease flares or to control chronic disease where emollients alone are ineffective
10
Q
Topical steroids
MOA
A
- Same as topical steroids
- With prolonged use of topical use of steroids can lead to systemic absorption and effects can occur
- It comes in: Mild, moderately, potent, and very potent
11
Q
Topical steroids
Adverse effects
A
- Uncommon
- Potent and very potent can cause skin thinning, striae, telangiectasia and contact dermatitis
- When used on the face, they can cause perioral dermatitis and cause or exacerbate acne
- Withdrawal of topical corticosteroids can cause a rebound worsening of the underlying skin condition
- Rarely, adrenal suppression and systematic adverse effects occur
12
Q
Topical steroids
Warnings
A
- You should not use topical steroids where the infection is present as this can cause the infection to worsen or spread
- Where facial lesions are present, potent steroids should be avoided and treatment courses should be short
13
Q
Topical steroids
Interactions
A
- There are generally no significant drug interactions when steroids are used topically
- If several topical agents are being used on the same area of skin, applications should be spaced out to allow absorption of pharmacologically active agents, emollients should be last
14
Q
Topical steroids
Administration
A
- Steroids should be applied thinly and only to the area of skin where the disease is active
- You may find that creams are easier to apply to most lesions, while ointments are more suitable where the skin has become thick and leathery
- Was hands-on application
15
Q
Inhaled Steroids
Common indications
A
- Asthma- treat airway inflammation and control symptoms at step 2 of therapy where asthma is not adequately controlled by a short-acting B-agonist alone
- COPD- control symptoms and prevent exacerbations in patients who have severe airflow obstruction or spirometry and/or recurrent exacerbations. Inhaled steroids are usually prescribed in combination with a long-acting b-agonist
