Systemic Steroids Flashcards
Steroids are used for a variety of conditions, including inflammatory conditions, immune suppression, and __________
adrenal insufficiency
to replace endogenous steroids that the adrenal gland is not producing (cortisol and aldosterone)
fludrocortisone replaces what endogenous steroid?
aldosterone
Any steroid replaces what endogenous steroid?
cortisol
This steroid mimics aldosterone.
It has mineralocorticoid activity, which is used to maintain a balance of water and electrolytes.
fludrocortisone
Fludrocortisone is FDA-approved for what disease?
What is it also used for off-label?
Addison’s disease
orthostatic hypotension
Commonly used steroids, such as prednisone and hydrocortisone, have more ___ activity
glucocorticoid activity
Does glucocorticoid activity have more or less anti-inflammatory effects?
more!
What is it called when systemic steroids can cause the adrenal gland to stop producing cortisol due to feedback inhibition?
suppression of the hypothalamic-pituitary-adrenal axis (HPA)
Why do long-term steroids need to be tapered off when they’re discontinued?
to give the adrenal gland time to resume cortisol production
This condition develops when the adrenal gland produces TOO MUCH cortisol, or when exogenous steroids are taken in high doses and the amount of cortisol produced is higher than what would have been produced naturally
Cushing’s syndrome
This condition happens when the adrenal gland is not making enough cortisol
Addison’s disease
Why should steroids not be stopped suddenly?
can be fatal! it can cause Addisonian Crisis
List some long-term effects of Steroids/cushing’s syndrome
1) glaucoma / cataracts
2) Acne
3) psych changes, HTN, hypothyroidism
4) GI bleeds, esophagitis ulcers
5) diabetes
6) poor bone health
7) impaired wound healing, infection
8) growth retardation, muscle wasiting
9) buffalo hump
10) pink-purple stretch marks (striae)
What can happen to women taking long term steroids?
hair growth on face and body (hirsutism)
irregular or absent menstrual periods
What are ways to reduce systemic steroid risk?
1) alternate day dosing (QOD) – decreases Cushing-like side effects
2) joints – inject into the joint
3) for a condition in the gut, use a steroid with low systemic absorption (ie budesonide - Entocort EC)
4) asthma - use inhaled steroids
5) lowest dose possible
What are the short acting systemic steroids?
cortisone - 25mg
hydrocortisone - 20mg
What are the intermediate-acting systemic steroids
prednisone - 5mg
prednisolone - 5mg
methylprednisolone - 4mg
triamcinolone- 4mg
What are the long-acting and highest potency systemic steroids?
dexamethasone - 0.75mg
betamethasone - 0.6mg
List the steroids least potent to most potent
cortisone - 25mg hydrocortisone - 20mg prednisone - 5mg prednisolone - 5mg methylprednisolone - 4mg triamcinolone- 4mg dexamethasone - 0.75mg betamethasone - 0.6mg
“Cute Hot Pharmacists and Physicians Marry Together & Deliver Babies”
Brand: DexPak 6, 10 or 13 days, Decadron
generic: dexamethasone
Brand: Solu-Cortef
generic: hydrocortisone
Brand: Medrol, Solu-Medrol
generic: methylprednisolone
Brand: Deltasone
generic: prednisone
Brand: Millipred, Orapred ODT
generic: prednisolone
Brand: Kenalog
generic: triamcinolone
What is the prodrug of cortisol?
cortisone
what is the prodrug of prednisolone?
prednisone
Which steroid is available in a therapy pack and as an injection?
methylprednisolone
