Therapeutic steroids

Question 1

List some of the therapeutic uses of glucocorticoids

Answer 1

• Anti inflammatory
• Anti allergy
• Immunosuppressive
• Shock
• Metabolic (ketosis)

Question 2

Discuss the use of cortisol in therapy

Answer 2

-Very short half life: ~60 mins
-Hydrocortisone- a synthetic form of cortisol
- You can make it more potent e,g, add a double bond= Prednisolone
or by methylation or fluorination

Question 3

What is the main glucocorticoid in some exotic species?

Answer 3

Corticosterone

Question 4

Which enzyme is used in the conversion of steroids?

Answer 4

11-beta HSD

Question 5

Give an example of a steroid drug that is good for anti inflammatory activity

Answer 5

Dexamethasone

Question 6

Give an example of a drug that has both high glucocorticoid and mineralocorticoid potency

Answer 6

Hydrocortisone

Question 7

How can you increase the half life?

Answer 7

By esterification= affects the solubility. The more insoluble the longer it remains in the body.

Question 8

What are the adverse effects of glucocorticoids?

Answer 8

• PUPD
• Hunger
• Increased risk of infection due to immunosuppression
• Iatrogenic hyperadrenocorticism (may present as acute hypoadrenocorticism)

Question 9

What are the signs of glucocorticoid steroid withdrawal?

Answer 9

• Depression
• Anorexia
• Vomiting
• Bloods similar to primary hypoadrenocorticism but Na/K are normal

Question 10

How do you avoid glucocorticosteroid withdrawal syndrome?

Answer 10

• Use minimum effective dose
• Short course
• Intermittent dose
• Taper the therapy off

Question 11

Discuss the analytical implications of steroid structure for diagnostic testing

Answer 11

• Prednisolone and cortisol have such a similar structure that immunoassays will pick up prednisolone and could give false high values.
• WHEREAS dexamethasone has a different enough structure that this doesn’t happen.
• HENCE why we use LDDS and HDDS tests not prednisolone ones