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Therapeutics > Steroids > Flashcards

Steroids Flashcards

1
Q

What are the three sections of the Adrenal Cortex?

A

Zona Glomerulosa
Zona Fasciculata
Zona Reticularis

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2
Q

Which zone of the adrenal cortex is testosterone produced?

A

Zona Reticularis

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3
Q

Which zone of the adrenal cortex is Cortisol produced?

A

Zona Fasciculata

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4
Q

Which zone of the adrenal cortex is Aldosterone produced?

A

Zona Glomerulosa

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5
Q

What are the 4 primary functions of Cortisol?

A

Mediate Stress Response
Regulate metabolism
Regulate inflammatory response
Regulate Immune system

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6
Q

What does Cortisol inhibit when produce in excess?

A

CRH from the hypothalamus

The production of ACTH from the pituitary

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7
Q

Where does Cortisol affect inflammation? (5)

A
  1. Altering Cytokine release
  2. Blocking Capillary permeability
  3. Causing less vasoactive substance release
  4. Inhibiting leukocyte and macrophage migration/adhesion
  5. Interfering with phagocytosis
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8
Q

Where does Cortisol affect Immunosuppressive? (5)

A

Altering cell funciton
Affecting WBC
Inhibiting T-Cell activaiton
Inhibiting IL, cytokines, TNF-a

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9
Q

What are the other corticosteroid actions?

A

Anti-mitotic activity (Psoriasis)
Anti-tumour effects
Anti-emetic effects (N/V)

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10
Q

What are the various dosage forms of Corticosteroids?

A

Local
Otic, Opthalmic, inhaled, topical

Systemic
Injectables, Oral

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11
Q

What are the 4 topical corticosteroids dosage forms?

A

Lotions
Creams
Gels
Ointments

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12
Q

What is the most potent level of steroids

A

1

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13
Q

What is the least potent level of steroids

A

7

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14
Q

What does Occlusion mean

A

Occlusives are moisturizing agents that work by forming a protective layer on the surface of your skin and create a barrier to prevent moisture loss,

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15
Q

How often can a join be infected in injectable corticosteroids?

A

3-4 times a year. More risks HPA suppression

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16
Q

What is the most potent Topical Corticosteroid cream (1)

A

Clobetasol Proprionate

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17
Q

What are the two mid potency corticosteroid creams

A

Betamethasone Diproprionate (3)

Betamethasone Valerate (5)

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18
Q

What is the least potent corticosteroid cream?

A

Hydrocortisone (7)

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19
Q

What are the usual sites for intralesional injections?

A

Within the lesion of the affected area

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20
Q

What is the usual sites for intra-articular injections?

A

Hip, knee, ankle, shoulder, elbow, wrist

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21
Q

What is considered a low dose or maintenance dose of prednisone?

A

5-15mg/d

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22
Q

What is considered a moderate dose of prednisone?

A

0.5/kg/d

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23
Q

What is considered a high dose of prednisone?

A

1-3mg/kg/d

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24
Q

What is considered a massive dose of prednisone?

A

15-30mg/kg/d

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25
Q

Care
Health
Professionals
Put
Money
(in)
T
D
Bank

A

Cortisone
hydrocortisone
prednisone
prednisonolone
methylprednisolone
triamcinolone
dexamethasone
betamethasone

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26
Q

What are some common side effects of ophthalmic steroid uses?

A

Stinging, redness, tearing, secondary infection

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27
Q

What are some common side effects of inhalated corticosteroids

A

Thrush
Hoarseness
Drymouth
Dysphoria

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28
Q

What are some common side effects of nasal instillation steroids

A

Rhinorrhea
Burning
Sneezing
Bloody nose

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29
Q

What are some side effects of topical corticosteroids?

A

Burning
Irritation
Skin atrophy

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30
Q

What are the early CNS effects of corticosteroids?

A

Euphoria
Insomnia
Restlessness
Memory Impairment

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31
Q

What are the later CNS effects of CS

A

Altered Mood
Depression
Mania
Psychosis

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32
Q

What eye condition can CS increase a risk of?

A

Cataracts
Glaucoma

Can be a risk factor of both topical and oral, but more so topical

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33
Q

What is Hypercortisolism?

A

Alters the fat distribution and occurs as centripetal obesity

Moon face
Buffalo hump
Protuberant abdomen

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34
Q

What should be reminded when taking steroids?

A

Follow dosing, Take with food

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35
Q

What medications should not be taken with steroids in conjunction?

A

NSAIDS Increased stomach upset

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36
Q

What does the useage of steroids do to glucose levels?

A

Increase in blood glucose hence it should be monitored. (Harder in non-diabetes then diabetes_

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37
Q

What happens to sodium/water with CS’s?

A

Retention hence increased levels

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38
Q

T or F does CS increase appetite?

A

True, hence can be used a cancer therapy together

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39
Q

Which Dosage form of CS growth retardation usually occur with?

A

Oral

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40
Q

How much does physiological cortisol get secreted?

A

10-20mg/d (Cortisol)

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41
Q

What does HPA axis suppression mean for the patients?

A

They will not be able to have an adequate stress response.

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42
Q

What will happen to an individual if they stop CS abrudtly?

A

Hypotension
Hypoglycemia
Flu like symptoms
Weight Loss
Confusion

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43
Q

Does more HPA axis suppression occur at 10mg QID or 40mg QD

A

10mg QID

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44
Q

What factors may predict occurence of HPA-axis suppression

A

Steroid
Dose
Interval
Route
Administration

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45
Q

How does it take to recover of HPA axis supression?

A

1 to 3 years after cessation of exogenous steroid use

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46
Q

What happens to our risk of infection while one CS?

A

Increases Generally cumulative dose <700mg or <10mg/d is not occuring though

47
Q

What can happen with skin/connective tissue?

A

Acne, Bruising, Thin Skin
Striae, impaired wound healing

48
Q

What does CS do to bone density?

A

Decrease CA Absorption and bone loss can occur.

Loss associated with dose and duration

Leads to HIGH incidence of Osteoperosis

49
Q

What is the other bone related condition that can occur with long term CS useage?

A

Osteonecrosis

50
Q

How does muscle Myopathy occur with CS useage? Dosage?

A

Occurs at >10mg/day or prednisone

Decreased protein synthesis in the muscle

51
Q

Short term use of oral CS?

A

Does not mitigate all risk.

52
Q

What is the recomended dosage for Covid patients?

A

Dexamethasone 6mg OD for up to 10 days

53
Q

What is the optimum EOD dosing?

A

2.5 to x the minimum effective concentration. This is to help achieve a new MED

54
Q

What circumstances does stress dosing occur?

A

Moderate illness
Major Surgery

55
Q

What is steroid pulse therapy?

A

Short term high dose IV or PO steroid in various situation where rapid remission of serious conditions is desired

56
Q

What is the diurnal cycle of HPA-axis?

A

Endogenous levels of CS highest at 7-8am and fall throughout the day

57
Q

What is the anti-inflammatory potency of Cortisone?

A

0.8

58
Q

What is the anti-inflammatory potency of Hydrocortisone

A

1

59
Q

What is the anti-inflammatory potency of Prednisone

A

4

60
Q

What is the anti-inflammatory potency of Prednisolone

A

4

61
Q

What is the anti-inflammatory potency of Methylprednisolone

A

5

62
Q

What is the anti-inflammatory potency of Triamcinolone

A

5

63
Q

What is the anti-inflammatory potency of Dexamethasone

A

25

64
Q

What is the anti-inflammatory potency of Betamethasone?

A

25

65
Q

What is the major mineralocorticoid secreted by the adrenal glands?

A

Aldosterone, but mostly controlled by the RASS

66
Q

What are the impacts of aldosterone secretion?

A

Increased plasma volume, elevated BP, Hypokalemia

67
Q

Which group of individuals have higher risk of cushings syndome?

A

Women over men (5 :1)

68
Q

How common is endogenous cushings syndrome?

A

Rare, but seen at around age 45 if it does occur

69
Q

For the endogenous causes of Cushings disease where does it act?

A

80% a benign tumour on the pituitary over producing ACTH

20% being that there can be an adrenal gland tumor or a tumor that produces cortisol

70
Q

What is the exogenous causes of cushings syndrome?

A

The administration of CS

71
Q

What is difficult about diagnosis of cushings?

A

Establishing the source of overproduction (If endogenous)

72
Q

What is cushings disease?

A

Hypercortisolism disease

73
Q

What is the most common sign(s) of cushings (5) >85%

A

Obesity
Facial plethora
Rounded face
Decreased libido
Thin skin

74
Q

What are the good indicators that help distinguish cushings from general obesity

A

Think skin, unsual bruising, muscle weakness

Also see less decreased growth in children

75
Q

What is the morbidity and mortality of cushings left untreated?

A

50%

76
Q

What is the treatment goals of Cushings disease?

A

Remove source of hypercortisolism
Restore cortisol secretion
Reverse clinical features
Prevent dependency

77
Q

What is the first treatment of cushings?

A

Surgery to remove the tumour or radiotherapy

78
Q

What are some drugs that can be used to inhibit steroidogenesis?

A

Ketoconazole
Metyrapone
Mitotane

79
Q

What is the ACTH secretion inhibitor?

A

Pasireotide

80
Q

What is the MOA of ketoconazole?

A

Inhibits 11 beta and 17 alpha hydroxylase

Blocks synthesis of cortisol in adrenals

81
Q

What is the MOA of Metyrapone?

A

Inhibits 11 B Hydroxylase, similar stops syntheisis of cortisol via a different pathway

82
Q

What is the MOA of mitotane?

A

Inhibits cortisol production

Only started in hospital though as it greatly decreases cortisol synthesis

Has a major side effect profile of NVD

83
Q

What is Pasireotide?

A

Inhibition of ACTH secretion and is a subcu inejction

Very expensive and has a wide a large side effect profile.

Only given generally if other treatment failures occurred. (Cushings treatment)

84
Q

What is the cause of addisons disease?

A

Autoimmune-mediated destruction of the adrenal cortex

85
Q

What usually causes the autoimmune related issues of addisons?

A

ID, tumours, hemorrhage, injury to adrenal

86
Q

What is secondary adrenal insufficiency?

A

occurs when individuals go through withdrawals of CS after immediate cessation

87
Q

Signs and symptoms of addisons?

A

Fatique, weight loss, postural hypotension, skin hyperpigmentation, salt craving

Hypoglycemia

88
Q

What is the diagnosis of cushings based off of?

A

Persistent vague SE
Lab tests with biochemical abnormalities
Cortisol levels
Medical imaging

89
Q

What is the treatment of chronic adrenal insufficiency?

A

Glucocorticoids
HC dosage of 15-30mg a day split BID (20/10) generally

Mineralcorticoids
Fludricortisone 0.005-0.1mg qd (Titrate dose based on BP, Na, K levels)

90
Q

What do people with addisons disease need to do before excersize/activity?

A

Need to ad 5-10mg of HC to get them in the stress response zone

91
Q

What is the androgen therapy?

A

DHEA could be considered for low libido, Might also consider androgen replacement therapy for women

92
Q

What is the treatment of an acute adrenal crisis

A

HC dosage (Generally high) over 24 hrs

93
Q

What are the signs of undertreatment of addisons disease?

A

Symptome recurrence
Nonspecific symptoms

94
Q

What is the signs of overtreatment of addisons disease?

A

Weight gain
Hyperglycemia and hypertension
Osteopenia

95
Q

What are the main signs of gluco, mineralo- deficiency

A

Hypotension, shock unrespeonsive to vasopressors

96
Q

What is the treatment of acute adrenal crisis

A

Requires prompt IV glucocorticoids and fluid resucitiation

97
Q

With respect to HPA axis suppression what two pathways are suppressed generally?

A

CRH and ACTH

98
Q

The adrenal cortex is a secondary site for ___

A

Androgen synthesis

99
Q

How many cases of cushings disease is caused by endogenous overproduction of ACTH dependent?

A

80%

100
Q

How many cases of cushings disease is caused by endogenous overproduction of ACTH independence?

A

20%

101
Q

How is secondary adrenal insufficiency tested generally?

A

Clinical Presentation
Lab Tests
Cortisol Levels
Medical imaging

102
Q

What are the risk factors that can lead to cataract develoment?

A

Daily dos, cumulative dose, duration, age

103
Q

How long is topical opthalmic gels used for?

A

generally 2 weeks

104
Q

What should long term CS users do with respect to eyes?

A

Routine eye exams to examine whether steroid related damage is present

105
Q

What dose of prednisone do we see glucose intolerance start to occur?

A

> 15mg/d

106
Q

Which steroids have mineral corticoid activity?

A

Cortisol (1)
Hydrocortisone (1)
Prednisone 0.8
Prednisolone 0.8
methylprednisolone 0.5

107
Q

What is HPA axis suppression?

A

Where we have consistent suppression of the HPA axis via CS usage. negative response pathway

108
Q

What is the diurnal cycle?

A

Where we have our endogenous levels of cortisol be the highests in the am and decrease throughout the day

109
Q

What fold increase do we with cortisol during times of stress?

A

up to 10 fold release

110
Q

What are the targets of negative feedback?

A

CRH and ACTH

111
Q

How long does HPA axis suppression occur for?

A

1 to 3 years after cessation of exogenous steroids

112
Q

What type of blood test is performed to determine HPA-axis suppression/recovery?

A

SST or Short synacthen test

113
Q
A

Therapeutics (10 decks)

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