Derm Corticosteroids

Question 1

where are corticosteroids produced

Answer 1

adrenal cortex

includes androgens, glucocorticoids, and mineralocorticoids

Question 2

what are synthetic corticosteroids used to treat

Answer 2

inflammation, lymphocytes, immune function

binds cytoplasmic steroid receptors that go to DNA to induce or repress the expression of target genes

Question 3

low vs high dose effects of corticosteroids

Answer 3

low: anti inflammatory
high: immunosuppressive

Question 4

what are the anti inflammatory effects of corticosteroids

Answer 4

1. suppress genes for inflammatory cytokines
2. decrease neutrophil migration to target tissues (remains in circulation)
3. decreases eosinophil, lymphocyte, and basophils in circulation
4. increases lipocortin to inhibit PLA to decrease production of prostaglandins and leukotrienes

Question 5

immunosuppressive effects of corticosteroids

Answer 5

1. affect cell mediated immunity
2. decrease circulating lymphocytes by inducing apoptosis
3. decrease cytokines
4. interfere with antigen presentation by APCs

Question 6

what are dermatologic indications for corticosteroid use

Answer 6

1. pruritus
2. inflammation of skin/ear canals
3. acute allergic/hypersensitivity reactions
4. immune mediated or autoimmune diseases

Question 7

what type of administrations are used

Answer 7

systemic and topical

cannot achieve therapeutic dose without inducing side effects

Question 8

what are general side effects of corticosteroids

Answer 8

1. PU, PD, PP
2. muscle atrophy/weakness
3. infections (skin, UTI)
4. GI ulceration
5. adrenal suppression

Question 9

what are the skin side effects of corticosteroids

Answer 9

1. thin skin
2. comedones
3. hyperpigmentation
4. alopecia from telogen follicles
5. decreased elasticity
6. bruising
7. infection (pyoderma, fungal, demodex)

Question 10

corticosteroid side effects: dogs

Answer 10

1. PU, PD, PP
2. “pot belly” - hepatopathy + fat redistribution
3. “pred head” - muscle/collagen atrophy
4. UTI, incontinence
5. calcinosis cutis
6. hypertension

Question 11

calcinosis cutis

Answer 11

dystrophic calcification of the skin

erythematous papules coalesce and form gritty plaques, ulcerations, and crusts

Question 12

corticosteroid side effects: cats

Answer 12

1. PU, PD, PP
2. diabetes mellitus
3. congestive heart failure
4. ear tipping
5. skin fragility

Question 13

when are corticosteroids contraindicated in horses

Answer 13

horses with laminitis

Question 14

short acting corticosteroids

Answer 14

hydrocortisone, cortisone

less useful clinically

Question 15

intermediate acting corticosteroids

Answer 15

prednisone, prednisolone, methylprednisolone

most common; admin q24-48

Question 16

long acting corticosteroids

Answer 16

triamcinolone, dexamethasone, betamethasone

similar to intermediate but administered less frequently

Question 17

oral vs parenteral administration of corticosteroids

Answer 17

oral: safest, can control dose
- begin with induction dose (high) then taper to lowest therapeutic dose until admin q48

parenteral: cannot regulate or remove once administered (less controlled)

Question 18

corticosteroid dosage: anti inflammatory in dogs

Answer 18

induction: 1-2 mg/kg/day
maintenance: 0.5-1 mg/kg EOD

Question 19

corticosteroid dosage: immunosuppressive in dogs

Answer 19

induction: 2-4 mg/kg/day
maintenance: 1-2 mg/kg EOD

Question 20

corticosteroid dosage: anti inflammatory in cats

Answer 20

induction: 2-3 mg/kg/day
maintenance: 1-2 mg/kg EOD

Question 21

corticosteroid dosage: immunosuppressive in cats

Answer 21

induction: 4-6 mg/kg/day
maintenance: 2-4 mg/kg EOD

Question 22

corticosteroid dosage: prednisolone anti-inflammatory in horses

Answer 22

induction: 1-2 mg/kg/day
maintenance: 0.5-1 mg/kg EOD

Question 23

corticosteroid dosage: prednisolone immunosuppressive in horses

Answer 23

induction: 2-4 mg/kg/day
maintenance: 1-2 mg/kg EOD

Question 24

corticosteroid dosage: dexamethasone anti-inflammatory in horses

Answer 24

induction: 0.02-0.04 mg/kg/day
maintenance: 0.01-0.02 mg/kg EOD

Question 25

corticosteroid dosage: dexamethasone immunosuppressive in horses

Answer 25

induction: 0.04-0.08 mg/kg/day
maintenance: 0.02-0.04 mg/kg EOD

Question 26

side effects of topical corticosteroids

Answer 26

• skin atrophy
• comedones
• phlebectasia

increased risk of side effects with increased potency

percutaneous absorption in small pets can cause systemic side effects

Question 27

what species require prednisone vs prednisolone

Answer 27

prednisone: dogs only
prednisolone: cats and horses