Corticosteroids (Exam #3)

Question 1

Important immune system effect of Glucocorticoids?

Answer 1

ANTI-INFLAMMATORY

- Blocks all steps in inflammation (inhibits COX2)

Question 2

Diagnosis of Cushing’s Syndrome, and what are the three steps? What do results indicate?

Answer 2

Dexamethasone Suppression Test

1. Measure baseline cortisol in AM
2. Administer Dexamethasone in PM
3. Remeasure cortisol next AM

Disease if cortisol low
Syndrome if cortisol unchanged/high

Question 3

What is the one Mineralocorticoid drug, and under what conditions should it be used?

Answer 3

Fludrocortisone

- Combine with glucocorticoid for Aldosterone replacement

Question 4

What are the three classes of Glucocorticoids, and what are the differences between the three?

Answer 4

• 1st class: G = M effects
• 2nd class: G > M effects
• Other: almost all G effects

Question 5

Two drugs in 1st class of Glucocorticoids? Which is the active form?

Answer 5

• Hydrocortisone (ACTIVE)

- Cortisone

Question 6

Two drugs in 2nd class of Glucocorticoids? Which is the active form?

Answer 6

• Prednisone

- Prednisolone (ACTIVE)

Question 7

Two drugs in other class of Glucocorticoids?

Answer 7

• Triamcinolone

- Methylprednisolone

Question 8

Use of Hydrocortisone and Cortisone?

Answer 8

Replacement therapy in adrenal insufficiency

Question 9

Use of Prednisone and Prednisolone?

Answer 9

Anti-inflammatory (more G than M effects)

Question 10

Important note on each of the three main administrations of Glucocorticoids?

Answer 10

• Oral: long-term therapy
• Injections: emergency use
• Topical: caution systemic absorption if thin skin

Question 11

Two general treatment options for chronic Adrenal Insufficiency?

Answer 11

• Glucocorticoid alone

- Glucocorticoid + Mineralocorticoid

Question 12

When would treatment for chronic Adrenal Insufficiency be altered, and how?

Answer 12

Increase dose with stress or infection

• 2x for minor
• 10x for major (surgery, trauma)

Question 13

If an inflammatory condition is present, what is the recommended treatment? What are three examples of inflammatory conditions?

Answer 13

GLUCOCORTICOIDS

• Asthma
• RA (inhaled)
• Rhinitis (intranasal)

Question 14

What are three therapeutic guidelines for use of Glucocorticoids?

Answer 14

• Use lowest effective dose (taper as needed)
• Use local if possible
• Give on alternate days to avoid systemic AEs

Question 15

With use of glucocorticoids, what is considered short-term therapy and what does this time frame reduce risk for?

Answer 15

1-2 weeks

- Short-term use is less likely to cause problems

Question 16

What AE can be seen with short-term use of Glucocorticoids?

Answer 16

CNS (insomnia, restlessness)

Question 17

What three things should be monitored for with Adrenal Insufficiency and use of Glucocorticoids?

Answer 17

• Hypokalemia
• Na retention/edema
• Peptic ulcers

REST of them make sense (infection, osteoporosis, hyperglycemia, poor growth/development in children)

Question 18

Use of Mifepristone?

Answer 18

Inoperable Cushing’s patients

- Acts immediately

Question 19

How does Ketoconazole differ from Mifepristone in terms of action onset?

Answer 19

• Ketoconazole: inhibits nuclear receptors = takes time

- Mifepristone: immediate hypercortisolemia relief = works quickly

Question 20

Uses of Spironolactone (2)?

Answer 20

• Hyperaldosteronism

- Hirsutism