Steroids Flashcards
T/F: Steroids are chemical messengers that transport signals intracellularly, having a distinct 4 ring, 17 C structure, and are derived from cholesterol precursor.
True
What are the classes of steroids?
Glucocorticoids, Mineralcorticoids, Androgens and Vitamin D.
Where are steroids produced in the body?
Steroids are produced in the outer (cortex) of the adrenal gland.
T/F: Glucocorticoids main function in the body is homeostasis regulation.
True. The functions of the different classes of steroids are as follows;
GLUCOCORTICOIDS–>Homeostasis regulation
MINERALOCORTICOIDS–>Fluid & electrolyte balance–> control blood pressure
ANDROGENS–>Secondary sexual characteristics
What is the most commonly prescribed oral steroid?
Prednisone
T/F: The potency of steroid drugs is given in relative to hydrocortisone (20mg of hydrocortisone having potency of 1).
True.
When are cortisol levels highest in the body?
In the morning, 8A.M.
How do steroids act?
- steroids act early in the inflammatory pathway. They induce a protein Lipocortin/lipomodulin. Lipomodulin then inhibits activity of phospholipase 2 and block all three pathways.
- so in this manner steroids act INDIRECTLY in the inflammatory-pathway.
What happens when you suddenly discontinue steroid therapy?
Abrupt discontinuation of steroid therapy results in a dramatic axis upregulation due to the suddenly low circulating levels.
T/F: Corticosteroid therapy suppresses the HPA Axis.
True
T/F: Steroids are anti-inflammatory.
True
T/F: Topical formulation is the most common form of steroid used in eye care
True.
What are the general adverse reactions of steroids?
Increased hunger, Mental instability, Muscle fatigue, Blurred vision, Hair pattern changes, Easy bruising, Acne, Osteoporosis, Swelling, Xanthomas(yellow patch on skin), Diabetic complications, Peptic ulceration, Hypertension, Mood changes, Delayed wound healing, Adrenal insufficiency, Growth inhibition, Immunosuppression
Cushing’s syndrome
T/F: Cushing’s syndrome is most commonly iatrogenic adverse reaction of steroids.
True.
What are the systemic contraindications to steroids?
Active viral infection TB Fungal infection Immunosuppression Peptic ulcer Osteoporosis Psychosis Pregnancy
What is the only topical “ester-based” steroid in eye care?
Lotemax/Alrex (generic name: Loteprednol etabonate)
since it is ester based, it is quickly metabolized in the eye.
What is the benefit of ester based steroids in eye care?
Ester-based steroids have much less potential to cause cataracts or elevated IOP since ketone-based steroids are not broken down by anterior chamber esterases
What is the only PF topical ophthalmic steroid in the US
Lotemax/Alrex (in ointment form)
*Is also the only topical “ester-based” steroid in eye care
How do steroids prevent neovascularization of the cornea?
Steroids prevent neovascularization in the cornea by downregulating vascular endothelial growth factor [VEGF] synthesis.
What are the ocular adverse reactions of steroids?
Transient ptosis Secondary infection Epithelial keratopathy or keratitis Mydriasis Uveitis *Elevated IOP *Posterior subcapsular cataract (PSC) Corneal/scleral thinning Retinal ischemia *Retinal detachment Epiretinal membrane Optic nerve atrophy
T/F: Steroids can inhibit healing by inhibiting fibroblasts
True
Explain HPA axis’s normal function.
Hypothalamus releases corticotropin releasing hormone (CRH) -> Pituitary (anterior) releases adrenocorticotropic hormone (ACTH) from adenohypophysis -> Adrenal gland releases glucocorticoid (Cortisol) which has negative feedback on hypothalamus and pituitary, opposite to epinephrine and norepinephrine
Which drugs enhance steroid metabolism?
Barbiturates
Phenylbutazone and
Phenytoin
How do steroids promote coagulation?
Steroids may promote coagulation by reducing prostacyclin levels
