Steroids and DMARDS Flashcards
A 45-year-old female patient with a history of rheumatoid arthritis presents with joint pain and swelling. She has been on prednisone 10 mg daily for the past six months. She complains of weight gain, mood swings, and easy bruising. On examination, her blood pressure is elevated. What is the likely diagnosis, and what management steps should be taken?
The likely diagnosis for this patient is Cushing’s syndrome, which is caused by chronic glucocorticoid therapy. Management steps include gradually tapering the prednisone dose to the lowest effective level, considering alternative immunosuppressive agents for the treatment of rheumatoid arthritis, and addressing the associated complications such as hypertension and weight gain.
A 30-year-old male patient with a history of asthma presents with acute exacerbation of symptoms. He is currently on inhaled corticosteroids and a short-acting beta-agonist as needed. However, his symptoms are not well controlled. What is the next step in management?
In this case, since the patient’s symptoms are not well controlled, the next step in management would be to initiate systemic corticosteroid therapy, such as oral prednisone, to achieve quick control of the asthma exacerbation. The duration and dose of systemic corticosteroids will depend on the severity of the exacerbation and the patient’s response to treatment.
A 55-year-old male patient with a known history of systemic lupus erythematosus (SLE) presents with worsening fatigue, malaise, and joint pain. Laboratory investigations reveal low hemoglobin, elevated erythrocyte sedimentation rate (ESR), and positive antinuclear antibodies (ANA). What is the most appropriate treatment option for this patient?
Given the patient’s clinical presentation and history of SLE, the most appropriate treatment option would be to initiate systemic glucocorticoids, such as prednisone, at a dose sufficient to control disease activity. Depending on the severity of symptoms and involvement of specific organs, additional immunosuppressive agents may also be considered in conjunction with corticosteroid therapy.
A 60-year-old female patient with a history of chronic obstructive pulmonary disease (COPD) presents with frequent exacerbations requiring multiple courses of systemic corticosteroids each year. She is concerned about the long-term side effects of corticosteroid therapy. What alternative treatment options can be considered to minimize corticosteroid use?
In this case, alternative treatment options to minimize corticosteroid use in COPD exacerbations include the use of inhaled corticosteroids in combination with long-acting bronchodilators as maintenance therapy to reduce the frequency and severity of exacerbations. Additionally, non-pharmacological interventions such as smoking cessation, pulmonary rehabilitation, and vaccination against respiratory infections should be emphasized to optimize COPD management and reduce reliance on systemic corticosteroids.
What is the primary mechanism of action of corticosteroids?
The primary mechanism of action of corticosteroids is through binding to intracellular receptors, leading to modulation of gene expression and subsequent anti-inflammatory, immunosuppressive, and metabolic effects.
Name the three main types of corticosteroids.
The three main types of corticosteroids are:
- glucocorticoids
- mineralocorticoids
- adrenal androgens.
Which corticosteroid is known for its mineralocorticoid activity?
Aldosterone is the corticosteroid known for its mineralocorticoid activity. It regulates salt and water balance in the body.
What are the therapeutic uses of glucocorticoids?
Glucocorticoids have various therapeutic uses, including the treatment of inflammatory conditions, autoimmune diseases, allergic reactions, and certain types of cancer.
List some common side effects of long-term corticosteroid use.
Common side effects of long-term corticosteroid use include:
- weight gain
- fluid retention
- increased appetite
- mood changes
- osteoporosis
- muscle weakness
- increased risk of infections
- glucose intolerance.
What is the difference between systemic and topical corticosteroids?
Systemic corticosteroids are taken orally or by injection and exert their effects throughout the body. Topical corticosteroids, on the other hand, are applied to the skin or mucous membranes and primarily act locally.
Name a corticosteroid that is commonly used in the treatment of asthma.
Beclomethasone
How do corticosteroids suppress the immune system?
By inhibiting the production and function of various immune cells, such as lymphocytes and cytokines.
What is the role of corticosteroids in the management of autoimmune diseases?
To suppress the immune response and reduce inflammation associated with these conditions.
Explain the concept of adrenal suppression associated with corticosteroid therapy.
Adrenal suppression occurs when exogenous corticosteroids are administered for a prolonged period, leading to decreased production of endogenous corticosteroids by the adrenal glands.
Which corticosteroid is preferred for short-term use due to its minimal mineralocorticoid effects?
Dexamethasone
