Steroids

Question 1

Which steroids has the same level of effect as glucocorticoid and mineralocorticoid? and what are their duration of action?

Answer 1

Cortisol and hydrocortisol

short

Question 2

Which steroids is a potent glucocorticoid w/o aldosterone effect? and what is its duration of action?

Answer 2

Dexamethasone

Long acting

Question 3

What is glucocorticoid’s effect on leukocyte?

Answer 3

Inhibit leukocyte migration

Question 4

What does chronic use of glucocorticoid cause?

Answer 4

Cushing’s syndrome/osteoporosis

Question 5

What is chronic glucocorticoid’s effect in stomach?

Answer 5

Inhibit PGs—>increase acid and pepsin release

Question 6

Which 2 steroids have side effect such as HTN and edema?

Answer 6

Mineralocorticoid—>cortisol/hydrocortisol

Question 7

Sudden stop of steroid tx can cause?

Answer 7

Adrenal insufficiency (Addison’s disease)

Question 8

How to minimize steroid toxicity?

Answer 8

Alternative day therapy/local application/tapering down

Question 9

What are responsible for early asthmatic response?

Answer 9

Histamine and leukotriene

Question 10

What drug can be used to test for asthma?

Answer 10

Look for hyper reactivity with methacholine (M agonist)

Question 11

What do you see with late asthmatic response?

Answer 11

eosinophil and lymphocytes in the airway

Question 12

How to approach asthma tx?

Answer 12

Bronchodilator and anti inflammatory

Question 13

Adenosine cause bronchoconstriction or dilation?

Answer 13

Bronchoconctriction

Question 14

What are the SABA and what are they used for?

Answer 14

Shorting acting beta 2 agonist—>DOC for acute asthma attack
Also prophylaxis for exercise induced asthma
Albuterol/metaproterenol/terbutaline

Question 15

What are the LABA and what are they used for?

Answer 15

Long acting beta 2 agonist—>salmeterol/formoterol

Prophylaxis for nocturnal asthma

Question 16

How is SABA and LABA administered and what happens with overuse?

Answer 16

Aerosol form

Anxiety/muscle tremor (beta2 effect on muscle)/cardiotoxicity

Question 17

Ipratropium and tiotropium is most commonly used for asthma or COPD?

Answer 17

COPD

Question 18

What is the mechanism of theophylline?

Answer 18

Inhibit phosphodiesterase type 3—>prevent degradation of cAMP—>bronchodilate
Block adenosine—>bronchodilate

Question 19

Why is theophylline dangerous to use? and what is its toxicity?

Answer 19

Low TI—>interact with P450 inhibitors

High dose causes increase HR and arrhythmia

Question 20

What drugs prevent mast cell degranulation thus have anti inflammatory effect? How are they used?

Answer 20

Cromoglycate and nedocromil

Alternative to glucocorticoid for asthma prophylaxis

Question 21

What is MOA of omalizumab and what is it used for?

Answer 21

Anti-IgE—>prevent mast cell degranulation

Used subcutaneously for severe allergy induced asthma

Question 22

What are the anti inflammatory drugs for asthma? how are they administered and what should you worry about?

Answer 22

budesonide/flunisolide/fluticasone

Inhalation—>risk for oral thrush

Question 23

Which steroid is used intranasaly for allergy?

Answer 23

Fluticasone

Question 24

How are “lukast” drugs given? and how are they used?

Answer 24

Orally

Prophylaxis