Therapeutic steroids Flashcards
What are the therapeutic effects of glucocorticoids (corticosteroids)?
What is the half-life of cortisol?
~60mins
What is hydrocortisone?
pharmaceutical cortisol
What are the ways to enhance potency?
C1-2 double bond
Methylation
Fluorination
Why is giving prednisone less effective in horses
horses cannot convert prednisone to prednisolone very well
What esters can be added to enhance half life of steroids and what ways are they administered?
Acetonide - IM (least soluble - longest acting)
Acetate - IM
Sodium phosphate - IV or IM
Sodium succinate - IV or IM (most soluble - shortest acting)
What are the adverse impacts of corticosteroids (glucocorticoids)
Short term effects
Risk of too much anti-inflammatory action or immunosuppression
Risk of too much multi-system metabolic cortisol effect
Risk of too much -ve feedback on HPA axis
What are the short term adverse effects of corticosteroids?
- PU/PD
- hunger
- liver enzyme induction
What is the impact of too much anti-inflammatory action or immunosuppression due to corticosteroids
- infections, sepsis
- failed wound healing
- GI haemorrhage
what is the cause of too much -ve feedback on HPA axis due to corticosteroids
- when glucocorticoids withdrawn => temporarily can’t make ACTH so cannot cope with stress (adrenocortical arophy)
What are the effects of corticosteroid withdrawal syndrome?
depression
anorexia
vomiting
vague illness
abdominal discomfort
similar to primary hypoadrenocorticism but normal Na/K
In stressful situation:
- collapse
- vascular collapse
- GI haemorrhage
- shock
How can corticosteroid/glucocorticoid withdrawal syndrome be mitigated?
minimum dose possible for clinical effect
Least potent steroids for needs
Short acting so can control
Intermittent dosing
Tapered therapy
How can we tell if the signs of HAC are due to exogenous steroids?
only ACTH stim is useful for detecting iatrogenic HAC
Shrunk adrenals - stim test to try to get adrenals working
Name some short acting glucocorticoids/corticosteroids
Hydrocortisone (cortisol)
Cortisone (needs to be converted to hydrocortisone)
