15. Glucocorticoids

Question 1

Pathaway of glucocrticoid release

Answer 1

1. Hypothalamus → CRF (corticotropin release factor)
2. Hypophysis → ACTH (AdrenoCorticoTropic hormone)
3. Adrenal cortex → cortisole

Question 2

Physiological and pathological effects of glucocorticoids

Answer 2

⋆ Diabetogenic
⋆ Gluconeogenesis increases → hyperglycaemia
⋆ muscle atrophy, weakness
⋆ osteoporosis
⋆ delayed wound healing (Decrease collagen synthesis)
⋆ Skin thinning, alopecia
⋆ Decreased growth
⋆ Polyuria/polydipsia

Question 3

Pharmacological effects of glucocorticoids

Answer 3

⋆ Antinflammatory
⋆ Antiallergic
⋆ Immunosuppressive
⋆ Antishock
⋆ Neuroprotective

Question 4

What is the target of glucocorticoids?

Answer 4

Phospholipase A2 (PLA2)

Question 5

Explain antiiflammatory and immunosupressive effects of glucocorticoids?

Answer 5

⋆ inhibition of PLA2 → COX enzyme expression decrease
⋆ interleukin expression ↓
⋆ TNF (tumor necrosis factor) and IFN (interferon) synthesis ↓
⋆ apoptosis in lymphocytes!! → lymphocytopenia
⋆ neutrophilia (demargination)

Question 6

Explain antishock effect of glucocorticoids

Answer 6

capillary membrane permeability ↓ → enhancing microcirculation

Question 7

Explain neuroprotective effect of glucocorticoids

Answer 7

Trauma → bleeding → local vasoconstriction → Ischaemia → lipid peroxidation → ROS → APOPTOSIS, NECROSIS

Glucocorticoids counteract lipidperoxidation and enhance microcirculation

Question 8

List of important glucocorticoids:

Answer 8

⋆ Cortisol
⋆ Prednisolone
⋆ Methylprednisolone
⋆ Triamcinolone
⋆ Betamethasone
⋆ Dexamethasone

Question 9

Glucocorticoids that are applied locally

Answer 9

⋆ Beclomethason
⋆ Fluticason

Question 10

Glucocorticoid that are applied orally?

Answer 10

⋆ Budesonide

Question 11

Side effects of glucocorticoids

Answer 11

⋆ HT-hypophysis-adrenal cortex axis inhibition
⋆ Gastric ulcers
⋆ Hepatopathy
⋆ Pancreatitis
⋆ Glaucoma, cataracta
⋆ Thinning of skin, delayed wound healing, alopecia
⋆ Polyuria/polydipsia
⋆ Polyphagia
⋆ Remobilizing fats
⋆ Muscle atrophy
⋆ Immunosuppression

Question 12

3 options of using glucocorticoids

Answer 12

1. High dosage, once (IV: e.g. shock, spinal trauma (allergy))
2. ADT (alternate day therapy) prednisolone, methylprednisolone
3. Long acting injections (depot) only if ADT not possible

Question 13

Recommended order of indications

Answer 13

1. Local usage (atopic dermatitis, otitis externa, mastitis)
2. Single injectable dose
3. Asthma, RAO → Inhalational usage
4. Intraarticular
5. ADT
6. Depot injections