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Pharm2 1 > Steroids > Flashcards

Steroids Flashcards

1
Q

What is Cushings vs Addisons?

A

Cushings: too much steroids
Addisons: not enough steroids

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2
Q

Who first described steroid disease?

A

Dr. Thomas Addison 1855

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3
Q

What were the initial methods of treating adrenal disease?

A
  • extracting small concentrations of cortical steroids from extracts
  • synthesis of cortisone, availability of ACTH
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4
Q

What is ACTH used for now?

A

diagnostic agent, NOT therapeutic

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5
Q

What happened in 1950?

A

synthesis of hydrocortisone

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6
Q

What does the cortex produce?

A
  • Mineralcorticoids
  • Glucocorticoids
  • Androgens
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7
Q

What does the medulla produce?

A

Epi, NE

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8
Q

What is the principal hormone of the adrenals?

A

Hydrocortisone

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9
Q

HC secretion is regulated by what 2 things?

A
  • ACTH (from pituitary)

- Corticotropin releasing factor (from hypothalamus)

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10
Q

What do glucocorticoids act on?

A

Membrane bound receptors and cystolic receptors (intracellular and extracellular)

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11
Q

Glucocorticoid interactions with nucleus cause what?

A

Genomic effects, turn genes off and on (potent effects)

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12
Q

What is the primary pharmacologic effect of glucocorticoids?

A

Suppression of DN Amediated synthesis of pro-inflammatory chemicals (LT, PG, cytokines)

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13
Q

What are the 7 adverse effects of glucocorticoids?

A
  • Gluconeogenesis (steroid induced DM)
  • Osteoporosis, increased Ca excretion
  • Delayed growth in kids
  • Suppresed allergic responses and Ab production
  • Reduced healing
  • Fat deposition (shoulders, face, abdomen)
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14
Q

Result of chronic use of steroids?

A

20mg of Prednisone for at least 14 days can suppress HPA system

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15
Q

Steroids must be _______

A

TAPERED! to reactivate HPA system and avoid acute adrenocortical insufficiency

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16
Q

Suppressed patients require what special thing?

A

increased stress dose steroids during stressful event

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17
Q

What is the average therapeutic daily dose of HC?

A

10 mg / day

18
Q

What is unique about topical and inhaled steroids?

A

do not typically achieve serum concentrations that may cause HPA suppression

19
Q

What is so potent it causes even inhaled steroid to accumulate?

A

Rotonovir

20
Q

Dexamethasone is used for what?

A

diagnostic test

It is highly lipophilic, acts on hypothalamus to suppress CRH secretion without altering serum corticosteroid levels

21
Q

An intact HPA axis will show what with D test?

A

normal suppression of cortical production (should see a decrease in serum cortisol levels)

22
Q

What is the naturally occurring hormone?

A

hydrocortisone

Short acting

Highly bound to cortisol binding globulin (CBG)

available PO and IV and OTC

23
Q

CBG levels are highest when?

A

at night, lowest in the morning

24
Q

What is the primary PO agent used in US?

A

Prednisone

Lipid soluble, well absorbed from gut, give in the morning

25
Q

What is the IV formulation of prednisone?

A

methylprednisolone (but no faster than PO, like warfarin)

26
Q

What are the a/e of prednisone?

A
  • Fat redistruction
  • Osteopenia
  • Reduced gastric mucus production
  • Depression / psychosis
  • Hyperglycemia
  • Weight gain
  • Hypokalemia
27
Q

What causes weight gain with prednisone?

A

sodium retention and increased appetite

28
Q

What are the rare a/e of prednisone?

A
  • Cataracts
  • Avascular necrosis
  • Menstrual disorders
  • Peptic ulcerations
    – Tendon rupture
    Thromboembolism
29
Q

What are side effects from the immune suppression of prednisone?

A
  • Low grade temp
  • Sore throat
  • Mouth ulcerations
  • Oral candidasis
30
Q

What is demargination?

A

when needed, WBC unstick from the vessel wall

31
Q

Steroids cause what?

A

Demargination, muck with the WBC count

32
Q

Increase in WBC and left shift (increase in bands) indicates what?

A

Infection

33
Q

Increase in WBC and no shift indicates what?

A

Steroids

34
Q

CAUTION with what and prednisone?

A

live vaccines- if 20mg/day for 14 days or more do not give live vaccine

35
Q

What is the oral methylprednisolone?

A

Medrol Dos-Pak

21 4mg tablets that last for 6 days

6 5 4 3 2 1

no risk of HPA suppression

36
Q

How many joint injections can you get per year?

A

3

37
Q

What is DOC for Addisons?

A

Fludrocortisone

38
Q

What is DOC for neurologic uses?

A

Dexamethasone

it is very lipophilic

also for thyroid storm

39
Q

What is special about newer agents?

A

Less likely to be absorbed (hydrophilic)

40
Q

How do you treat a pregnant patient?

A

lowest possible doses

avoid fluorinated agents (T F D B)

41
Q

What are the live vaccines?

A
  • MMR
  • Varicella
  • Zoster
  • Injectable influenza
  • Internasal influenza

Pharm2 1 (5 decks)

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