Steroids Flashcards
1
Q
Low potency Glucocorticoids
A
- Hydrocortisone
- DOA is 8-12 hours
- equal glucocorticoid & mineralocorticoid effect
- replacement for adrenal insufficiency
- closely mimic normal circadian rhythm
2
Q
Medium Potency Glucocorticoids
A
- Prednisone
- Prednisolone
- Methlyperednisolone
- Triamcinolone
- DOA 12-36 hours
- used in CA, inflammation, allergy, and autoimmune disorders
3
Q
High Potency Glucocorticoids
A
- Betamethasone
- Dexamethasone
- Budesonide
- DOA is 24-72 hours
- useful in skin disorders (psoriasis, dermatitis), neoplastic disorders, Crohn’s disease
4
Q
Mineralocorticoids Drugs
A
Fludrocortisone (Florinef)
5
Q
Glucorticoids Drugs
A
- cortisone and hydrocortisone
- Dexamethasone (Decadron)
- Betamethasone (Diprolene)
- Budesonide (Rhinocort)
- Triamcinolone
- Prednisone (Prednisone Intensol)
- Predisolone (Prelone)
- Methlypredisolone (Medrol)
- Desoximetasone (Topicort)
- Desonide (Tridesilon)
- Fluticasone (Flonase)
- Ciclesonide (Omnaris)
- Clobetasol (Clobevate)
6
Q
Adrenal Androgens Drugs
A
Dehydropiandrosterone (DHEA)
7
Q
Synthesis of Adrenal Steroids
A
- Adrenal Cortex has 3 layers that produce steroid hormones
- outer layer produce mineralocorticoids - aldosterone
- middle layer produce glucocorticoids -cortisol
- inner layer produce adrenal androgens - DHEA
8
Q
Mineralocorticoids synthesis and MOA
A
- Synthesis of Aldosterone: adrenal cortex is stimulated by angiotensim II to release aldosterone - effected by K+ levels and ACTH
- MOA: Aldosterone binds to mineralocorticoid receptor to affect gene transcription
- Fludrocortisone is replacement drug for pt with Addison’s disease - don’t replace aldosterone due to electrolyte disturbances
9
Q
Aldosterone acts on
A
- most important: stimulates the reabsorption of Na+ and associated passive reabsorption of water in tubule of kidney
- sweat and salivary glands
- mucosal cells in intestine
10
Q
High levels of Aldosterone causes
A
- fibrosis in heart and blood vessels
- vascular remodeling
- development of CHF
11
Q
Glucocorticoids MOA
A
- Steroid crosses cell membrane and binds to intracellular glucocorticoid receptor
- leads to change in gene transcription (reduction of synthesis of inflammatory cytokines, upregulation of synthesis of annexin A1)
- play important role in anti-inflammatory and immunomodulatory effects
- response can take hours to days
12
Q
Metabolic effects of Glucocorticoids
A
- cortisol is released by adrenal cortex in circadian diurnal pattern
- Release is greatly increased by stress
- also effects carbo, protein, and lipid metabolism, decrease bone formation, anti-inflammatory, immunosuppressive
13
Q
Carbohydrate and Protein Metabolism of Glucocorticoids
A
- Increase gluconeogenesis (glucose formation)
- Reduce glucose uptake and utilization by peripheral tissues
- Increase protein breakdown (catabolic effects)
- activate lipolysis (provides fatty acids for gluconeogenesis)
- Outcomes: decrease muscle mass, thinning of skin, hyperglycemia (worse for DM)
14
Q
Glucocorticoids impact on bone
A
-decrease calcium absorption
-increase calcium excretion
-antagonist to Vitamin D - no Ca+ absorption
-inhibit osteoblast activity
-osteroporosis
stunts growth
15
Q
Lipid Metabolism of Glucocorticoids
A
- long term elevation of glucocorticoids
- cause fat redistribution
- outcomes: increase fat in back of neck (buffalo hump), increase facial fat (moon face), loss of fat in extremities (thin legs), avascular necrosis of femur head (cause fx)
16
Q
Anti-inflammatory effects of Glucocorticoids
A
- steroids decrease the concentration, distribution & function of leukocytes at sites of inflammation
- suppress inflammatory cytokines & decrease macrophages & antigen presenting cell function
- decrease release of inflammatory mediators
17
Q
Effects of Corticosteroids
A
- CNS: insomnia, euphoria, depression
- GI: peptic uclers
- Endocrine: suppresses pituitary hormones (ACTH, growth, thyroid) - why we tapper
- Heme: increase RBC and platelets
- Fetal: help fetal lung development
18
Q
Immunosuppressive effects of glucocorticosteroids
A
- anti-inflammatory effects are increased with increased doses
- move from being anti-inflammatory to immunosuppressive
- large doses can decrease production of antibodies
19
Q
Major toxicities of Glucocorticodis
A
- insomnia and behavioral changes are commonly seen short term
- also see hyperglycemia and glucose intlerance
- high dose and tx over 2 weeks results in severe toxicities (DM, muscle weakness, weight gain, osteoporosis, increased infections, HTN)
20
Q
Glucocorticoids adrenal suppression
A
- tx over 2 weeks - suppress basal level of hormones secreted by adrenal gland
- body stops making native hormones
- need to gradually tapper off
21
Q
Iatrogenic Cushing’s Disease
A
- Cushing’s = excess production of glucocorticoids by adrenal gland
- Iatrogenic Cushing’s = side effects from high dose given by healthcare professional
22
Q
“Cushingoid”
A
- mnumonic for Cushing’s disease
- Cataracts
- Ulcers
- Skin : thinning/brusing
- Hypertension / hirsutism / hyperglycemia
- Infections
- Necrosis of femoral head
- Glycosuria
- Osteoporosis, obesity
- Immunosuppression
- DM
23
Q
Classification of Glucocorticoids
A
- classified by potency and duration of action
- duration of action is determined by potency not elimination half life
24
Q
Glucocorticoid Uses
A
- Diagnosis and tx adrenal gland disorders (uncommon) (Addison’s disease)
- Tx common clinical disease (asthma, allergic rhinitis, anaphylaxis, urticaria, allergies, severe dermatitis, Crohn’s, leukemia/lymphoma, lupus, RA, organ transplant)
25
Q
Doses of Steroids
A
- Without stress we produce 10-20mg/day of cortisone daily
- Physiologic dose: replacing what the body has made. ex: 5mg daily prednisone
- Supraphysiolgic: given to suppress inflammation - higher dose than the body needs
- low dose steroids is <20mg prednisone
- moderate dose are 20-40 mg prednisone
- high dose are >40 mg prednisone
26
Q
Contraindications in using steroids
A
- monitor blood sugar, Na+ retention (edema and HTN), hypokalemia, hidden infections, peptic ulcers, osteoporosis
- keep dose as low as possible
- careful in pt has CAD, HTN, PUD, TB, psychoses, DM, osteoporosis, glaucoma
27
Q
Steroids produced by adrenal cortex
A
- mineralocorticoids
- glucocorticoids
- adrenal androgens
28
Q
Steroids produce by adrenal medulla
A
-epinephrine
29
Q
Mineralocorticoids act on
A
Aldosterone
30
Q
Glucorticoids act on
A
Cortisol
31
Q
Adrenal Androgens act on
A
Dehydroepiandrosterone (DHEA)
