Anti-inflammatory Steroids

Question 1

Glucocorticoids help to?

Answer 1

maintain bp and CV function
slow the immune system’s inflammatory response
maintain levels of glucose in the blood
regulate the metabolism of proteins, carbs, fats

Question 2

Cortisol acts as?

Answer 2

Mineralocorticoid and Glucocorticoid
GC- means to increase serum glucose levels
MC- means to increase Na levels

Question 3

What are adrenal steroids bound to in the plasma?

Answer 3

corticosteroid binding protein (CBP) and/or plasma proteins (albumin)

Question 4

Feedback inhibition of HPA axis?

Answer 4

feedback inhibition by cortisol

Question 5

Clinical use of Steroids?

Answer 5

Treatment of endocrine disorders (adrenal insufficiency)

Acute inflammation/ Organ transplant/ Allergic inflammation

Question 6

Cells of inflammation?

Answer 6

have an ability to leave the vessel into tissue (basophil- mast cell, monocyte- Macrophage, Lymphocyte- Plasma cell)

Steroids block these

dampen the cascade of inflammation, dampen effect

Question 7

Steroids and inflammatory effect?

Answer 7

decrease arachidonic acids, decrease leukotienes and Prostaglandins
even broader anti-inflammatory effect than NSAIDs

Question 8

Anti-inflammatory action?

Answer 8

Suppress production of cytokines, prostaglandins, leukotrienes
decrease release of proinflammatory mediators
stabilize lysosomal membranes
cause vasoconstriction and decrease capillary permeability

Question 9

Immunosuppressive action?

Answer 9

change lymphocyte distribution
suppresses the activation of T lymphocytes
Inhibits monocyte and phagocyte production and function

Question 10

Synthetic steroids?

Answer 10

similar to cortisol
produce same effects but have different ratios of GC and MC potency
Chemical changes affect mainly for GC and MC receptors
Differing rates of elimination (half life)
cant seperate GC and anti-inflammatory effects

Question 11

Synthetic steroids? oral?

Answer 11

most are rapidly and completely absorbed

Question 12

Synthetic steroids? other?

Answer 12

topical- inflammatory skin
inhalation- therapy for asthma
intraarticular injection- joint inflammation
parerntal- emergencies (septic shock, severe acute asthma)

Question 13

Do you get side effects with topical?

Answer 13

yes

Question 14

Pharmacokinetics? DOA?

Answer 14

-potency at GC receptor

elimination half life

Question 15

Pharmacokinetics? ADT Alternate day therapy?

Answer 15

attempt to alleviate side effects
decreae likelihood of hypothalamic pituitary adrenal axis suppression
severe autoimmune and inflammatory disorders

Question 16

Stopping therapy/ indications for glucorticoid withdrawl?

Answer 16

max therapeutic benefit obtained
Sub-optimal theurapeutic response
Serious/ uncontrollable side effects (lumbar spine osteoporosis, hypertension)

Question 17

Why tapper drug?

Answer 17

flare-up of underlying disease

adrenal insufficiency due to HPA suppression

Question 18

when is HPA suppression unlikely?

Answer 18

GC dosing for under 3 wks

Treatment with alternate day dosing

Question 19

If HPA suppression is unlikey then?

Answer 19

wean off GCs as dictated by disease control

Question 20

When is HPA suppression likely?

Answer 20

Mod-hight daily dose GC for >3wks
evening/bedtime GC doses for >2wks
presence of a Cushingnoid appearance

Question 21

If HPA suppression is likely?

Answer 21

treat like secondary adrenal insufficiency (taper dose at rate to prevent both disease flare and symptoms of cortisol deficiency)
med alert bracelet, emergency med info card
preloaded syringe with decamethasone

Question 22

Adverse effects?

Answer 22

Steroid induced morbidity is a major problem in many transplant patients
Extensive use of steroids often results in disabling and life-threatening SAEs

Question 23

Skin and soft tissue adverse effects?

Answer 23

thinning of the skin and purpura

development of cushing like symptoms

Question 24

Eye Adverse effects?

Answer 24

cataracts

increased intra-ocular pressure

Question 25

GI tract Adverse effects?

Answer 25

gastritis
peptic ulcers
GI bleeding
syngergistic effect in combo with NSAIDs (prophylaxis with PPIs may be required)

Question 26

Renal function and systemic hemodynamics Adverse effects?

Answer 26

commonly promotes fluid retention (electrolyte imbalance, not a problem for normalt pts)
can raise blood presure

Question 27

MSK Adverse effects?

Answer 27

Osteoporosis
usually if someone has cushingoid affects and fat redistribution patient will have this

prevent/treat by following general approach for osteoporsis, ADT does not prevent bone loss

Question 28

GCs on MSK?

Answer 28

GCs inhibit Ca absorption in the gut, bone metabolism altered by a number of different mechanisms (increase bone resorption)
-effect through GC receptors, Increae osteoclastogenesis

Question 29

Bone metabolism altered by a number of different mechanisms?

Answer 29

increase bone formation
-inhibit osteoblast proliferation, stim apoptosis of osteoblasts and mature osteocytes, antagonism of anabolic action of PTH, decrease insulin like growth factor (IGF-1) and testosterone production

Question 30

Other MSK Adverse effects?

Answer 30

Muscle weakness (proximal motor weakness in upper and lower extremities)

Muscular atrophy/ wasting (direct catabolic effect on skeletal m)

Question 31

CNS Adverse effects?

Answer 31

Euphoria (slight increase in overall sense of well being commonly seen)

Pysch disorder (depression, anxiety, panic attacks, phobias)

Question 32

Metabolism Adverse effects?

Answer 32

Carb metabolism- (Hyperglycemia
Exacerbation of preexisting diabetes
New onset diabetes)

Lipid- (dyslipidemia)

Immune system (increase susceptibility to infections)