L35- Steroid Pharmacology (synthetic corticosteroids) Flashcards
list the types of uses for corticosteroids for adrenocortical insufficiency
- chronic
- acute
- undiagnosed acute attack
Addison’s disease:
- (1) main Sxs
- (2) Tx, including (3) as main precaution
1- weakness, fatigue, weight loss, hypotension, hyperpigmentation, inability to maintain fasting glucose
2- long-term (chronic) oral hydrocortisone (inc dose during stress) + fludrocortisone
3- do not give glucocorticoid w/o salt retaining activity
describe acute use of corticosteroids in adrenocortical insufficiency (for what, and what is used)
-for life threatening shock, infection, trauma
Large amounts parenteral corticosteroids + fluid and electrolyte correction
-administer salt retaining hormones once hydrocortisone levels are reduced (~5 days)
describe corticosteroid use in undiagnosed acute attack of adrenocortical insufficiency
dexamethasone (avoid interference with testing cortisol levels)
fluid / electrolyte replacement
list the adrenocortical hypo/hyper-function disorders requiring corticosteroids
Hypofunction:
-CAH (congenital adrenal hyperplasia)
Hyperfunction:
- Cushing’s syndrome / disease
- aldosteronism
CAH Tx
glucocorticoids –> ACTH suppression
1) treat initially as acute adrenal crisis
2) once stabilized –> oral hydrocortisone / prednisone + fludrocortisone
protect fetus in high risk pregnancies with dexamethasone
describe Tx of Cushing’s disease / syndrome
(excess glucocorticoids)
1) primary: via bilateral adrenal hyperplasia –> tumor removal, uni/bi-lateral adrenal ressection
2) secondary: ACTH pituitary adenoma –> tumor removal, irradiation of pituitary
**must receive high doses of cortisol before / after surgery (tapered dose to prevent withdrawal)
Aldosteronism:
- (1) main cause
- (2) Sxs
- (3) Dx drug
- (4) Tx drug
1- (primary) adrenal tumor (maybe malignant)
2- hypokalemia, alkalosis, hypernatremia
3- spironolactone
4- spironolactone
describe purpose of dexamethasone suppression test
Cushings’s disease:
- dexamethasone suppresses cortsol release
- must be pituitary dependent: no ectopic ACTH, corticol or adrenal tumor
describe possible corticosteroid treatments of a fetus
i) premature delivery is expected
ii) large dose glucocorticoids
iii) reduced incidences of respiratory syndrome
given IM- usually dexamethasone
list the immunologically related non-adrenal disorder uses of corticosteroids
Many inflammatory conditions: IBD, asthma, collagen vascular disorders (RA), ocular diseases (uveitis, optic neuritis, exophthalmos)
Allergic reactions: contact dermatitis, urticaria
Organ transplant rejection
Hodgkin’s lymphoma [prednisone]
list the uses of corticosteroids associated with abnormalities of the blood (content, amount, ect.)
- hematological disorders: anemia, leukemia
- hypercalcemia
- cerebral edema [dexamethasone]
- idiopathic orthostatic hypotension [fludrocortisone]
corticosteroid use:
- prophylatically in (1) Tx
- (2) organ besides adrenal gland
- (3) specific altitude sickness
1- CINV (chemotherapy induced vomiting)
2- renal disorders – nephrotic syndromes
3- mountain sickness (reverse alkalosis)
what are the main guidelines for corticosteroid treatment
- short term use –> few serious AEs
- best to use short or intermediate acting steroids
- long term use does have predictable toxicity
Corticosteroid AEs
- metabolic –> cushing’s (DM, muscle wasting, osteoporosis)
- peptic ulcers
- hidden infections
- myopathy (long-acting)
- nausea, dizziness, weight loss
- CNS: euphoria, psychosis, depression
- inc intraocular pressure (glaucoma), posterior subcapsular cataracts
- Na / fluid retention, hypokalemia
- growth retardation
- adrenal suppression (atrophy)
