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Pharm II exam 1 > Steroids > Flashcards

Steroids Flashcards

1
Q

What 3 chemicals are secreted by the adrenal cortex?

A

Minercorticoids, glucocorticoids, androgens

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2
Q

What 2 chemicals are secreted by the adrenal medulla?

A

Epi and NE

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3
Q

What is the principal steroid? How is its secreted regulated?

A

Hydrocortisone

Regulated by ACTH and CRF

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4
Q

What is the HPA axis?

A

Hypothalamus -> CRF -> Pituitary -> ACTH -> Adrenal Gland

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5
Q

T or F. Glucocorticoids work on receptors outside and inside nucleus.

A

T

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6
Q

Explain how steroids work.

A

Bind to receptors that have ‘genomic’ effects via DNA synthesis suppression/activation

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7
Q

Why would DNA synthesis have an effect on the cell?

A

It controls synthesis of pro-inflammatory chemicals - LTs, PGs, cytokines

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8
Q

Glucocorticoids are MESSY. Name 6 effects:

A
  1. Gluconeogenesis
  2. Catabolism
  3. Osteoporosis
  4. Delayed growth
  5. Fat deposition
  6. Reduced healing
  7. Suppressed allergic response and Ab production
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9
Q

What regimen of steroids do you need to worry about HPA suppression?

A

20 mg prednisone for 14 days

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10
Q

What happens if you do not taper steroids?

A

Acute adrenocortical insufficiency

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11
Q

What can you not forget to do for those on chronic steroids (achieving HPA suppression)?

A

stress dose 50-100 mg of HC IV

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12
Q

What is the average therapeutic daily dose of HC (endogenous)? prednisone?

A

10mg/d

2.5 pred

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13
Q

Topical and inhaled steroids typically do NOT achieve serum concentrations that cause HPA suppression. What is the exception?

A

Ritonavir

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14
Q

How do you test an intact HPA axis? How does it work?

A

Dexamethasone Suppression Test - D suppresses CRH, which should suppress cortisol levels. If cortisol levels do NOT lower, then there must be (1) an excess of ACTH from a pituitary problem or (2) excess cortisol from adrenal gland problem

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15
Q

How short/long-acting is Hydrocortisone? How is it available?

A

Short ~ 1 hr

PO, IV, OTC topical

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16
Q

HC is bound to CBG. At what time of the day are CBG levels highest and lowest?

A

Lowest in the AM

highest in the PM

17
Q

What is the half life of prednisone? Is it lipid/water soluble?

A

1-3h, effects within 2-8 hrs

Lipid soluble - well absorbed in the gut

18
Q

When should you administer prednisone?

A

AM

19
Q

What is the IV formulation of prednisone? Does it make sense to use it in order to get faster effects?

A

Methylprednisolone

No (similar to warfarin)

20
Q

What are 4 common AEs for prednisone?

A

Reduced gastric mucusa - peptic ulcer dz
depression and psychosis - hallucinations
weight gain - Na retention, increased appetite
hypokalema

21
Q

What are 6 rarer AEs for prednisone?

A 
avascular necrosis
tendon rupture
peptic ulcerations (esp w/ NSAIDS)
cataracts
menstrual DOs
thromboembolism
22
Q

What are some signs of immune suppression that present in those on steroids?

A

low grade temp
sore throat
mouth ulcerations that wont heal
oral candidiasis

23
Q

Explain the difference between a high white count from steroid use and from an infection.

A

steroid - no left shift

infection - left shift

24
Q

what is responsible for the high WBC count in those on steroids?

A

de-margination - concentrates the blood stream with WBCs

25
Q

T or F. It is dangerous to give someone who is on 25 mg prednisone x14 days a live vaccine. What about a killed vaccine?

A

T - >20 or >14 days = risk for infection

If it is killed, then it may just not get an immune reaction from it.

26
Q

Name the live vaccines.

A
  1. Intranasal flu
  2. MMR
  3. Varicella
  4. Varicella zoster
27
Q

What is Medrol Dos-Pak? what is the regimen? Does this allow for HPA suppression?

A

oral methylprednisolone
21, 4mg tabs….6 on Day 1, 5 on Day 2…1 on Day 6.
NO - only 6 days

28
Q

Name 4 fluorinated steroids

A
  1. Trimacinolone
  2. Fludrocortisone
  3. Dexamethasone
  4. Betamethasone
29
Q

Fludrocortisone is the DOC for what dz? It has strong/weak effects.

A

Addison’s

strong

30
Q

What is commonly used as potent IV agent, long-acting, lipophilic (good for neuro) and potent anti-inflammatory?

A

Dexamethasone

31
Q

Which drug is similar to dexamethasone?

A

betamethasone

32
Q

What is the first inhaled steroid you would use for asthma/allergic rhinitis? What are the others?

A 
Beclomethasone
Bud
Fluticasone
Mome
Clicle
Big butt follows me closely.
33
Q

How do newer inhaled agents differ from the old ones?

A

they are less likely to be absorbed (longer pulmonary residence times)

34
Q

2 things to remember about steroids and pregnancy…

A
  1. maintain lowest possible doses - HTN, GDM in mom

2. avoid fluroinated agents - they cross placenta

35
Q

How do you treat Cushing’s?

A

Aminoglutethimide (Cytadren)

Pharm II exam 1 (4 decks)

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