CPS: Corticosteroids

Question 1

34 year old female with progressive bloody diarrhea and tenesmus. 10lb weight loss with scope:

Her labs were stool C and S, O and P, c diff negative. No fever. Hb 119, MCV 83, platelets 487, WBC 7

Ferritin 75, Crp 34.

Dx?

Answer 1

severe colitis from rectum to at least splenic flexure.

CRP high indicating inflammation. normoctyic anemia indicates anemia to do inflammation.

she has ulcerative colitis.

Question 2

how to treat ulcerative colitis

Answer 2

1. induce remission in UC with steroids.

if moderate, use non-systemic steroid like budesonide.

if severe, use systemic steroid like prednisone,methylprednisone, dexamethasone.

2. maintenance therapy with immunosuppressant vedolizumab.

Question 3

endogenous glucocorticoids and mineral corticoids are produced in the ___ ___

Answer 3

adrenal cortex. the glucocorticoid receptor is expressed in nearly all cells and thus this set of drugs can affect body systemically.

Question 4

why does prolonged steroid use cause moon face

Answer 4

becuase of Mild Na+/water retention causing edema/puffiness.

Question 5

how do corticosteroids affect INNATE immunity

Answer 5

innate immunity

Question 6

how do corticosteroids affect adaptive immunity

Answer 6

Question 7

T/F corticosteorids are used as a maintenance therapy in IBD

Answer 7

false. it has been shown as an effective induction therapy but not as a maintenance therapy.

Question 8

adverse effects of corticosteroids

Answer 8

in reproductive system; can also delay puberty, fetal growth retardation, hypogonadism.

Question 9

T/f steroids increase the risk of infection and impairs wound healing

Answer 9

true.

there is a much higher risk for infection and impaired wound healing compared to immunomodulators and biologic medications.

overall, the shortest possible course and lowest dose should be used.

steorid-sparing maintenance therapy for long term disease control is highly recommended.

Question 10

why does budesonide have less toxicity than traditional corticosteroids?

Answer 10

due to extensive first pass metabolsim. 95% is cleared by the liver– only 5% enters systemic circulation

it is used as an induction therapy for IBD if the patient has a moderate flare. however, for a sever case, it is less effective than other systemic corticosteorids.

it is still not effective as a maintenance therapy.