Chapter 10 (corticosteroids and inflammation) Flashcards
(53 cards)
inflammation
served a protective function in body and helps us heal, but also causes pain and swelling
increased blood flow to damaged areas is helpful at the start…
but then we want relief from it because of the pain
corticosteroids were first helpful therapies for diseases like…
RA (rheumatoid arthritis), lupus, severe dermatitis, Crohn’s disease, asthma, anaphylaxis, food allergies, etc.
to treat inflammation, normally all that is needed is…
NSAIDs, ice, and immobilization
inflammation left unabated…
causes damage to areas inflammed like joints; chronic inflammation in body has been linked to heart disease
corticosteroids
groups of steroidal hormones all derived from cholesterol
Naturally occuring corticosteroid is cortisol, which is produced in the adrenal glands on top of the kidney
cortisol functions
modulate glucose levels and body responses to stress; temper the immune function and thereby decrease the inflammatory response; helps us stay awake but then we crash
cholesterol template produced what endogenous substances?
sex steroids (male=testosterone, dihydrotestosterone) (female=estradiol and others), mineralocoritcoids (regulate salt levels in body), and cortisol
Cushing syndrome
when people are taking prednisome for long periods of time; looks same as Cushing disease, people look cushinoid
Cushing disease
too much endogenous cortisol produced by adrenal glands, usually result of tumor in adrenal gland; people look cushinoid
eicosanoids
local hormones derived from the AA cascade that act locally at the tissue level to cause pain and inflammation among other things like regulating BP
molecules that make up eicosanoids
prostaglandins (PGs), thromboxanes (TXAs), and leukotrienes (LTs)
corticosteroid mechanism
inhibit the arachidonic acid cascade to a much greater degree than NSAIDs and that is why they are much better at stopping inflammation; but explains their side e’s
Block formation of AA so all eicosanoids (PGs, TXAs, and LTs) do not form
corticosteroid antiinflammatory action compared to NSAIDs
better antiinflammatory action in corticosteroids because they inhibit all aspects of the arachidonic acid cascade (they block the formation of AA)
Singlulair
montelukast; leukotriene inhibitor
NSAIDs like ibuprofen
inhibit COX1 (blocks turning AA into those PGs and TXAs made by COX1)
COX2 inhibitors like Celebrex
inhibit COX2 (blocks turning AA into those PGs and TXAs made by COX2)
leukotriene receptor blockers like Singlulair
inhibit lipoxegenase (blocks turning AA into LTs made by lipoxegenase)
hydrocortisone
cortisol-like drug synthesized as medicine
short-term effects of corticosteroids
pts. feel very good, often insomnia but pts. don’t mind b/c there is increased energy
long-term effects of corticosteroids
characteristic body habitus (body shape) and the person is said to be cushinoid;
Fat on shoulders, abdomen, and face (moon face), muscle loss on limbs, edema, easy bruising, increase cancer risk, hirsutism (hairyness), purple striae (red lines and stretch marks), immune suppression and poor wound healing, hypertension, fatigue, depression, truncal obesity
to avoid systemic corticosteroid effects…
corticosteroids are used regionally or locally to reduce effects; use drugs that are intentionally built to be poorly absorbed
systemic use corticosteroids
oral prednisone, IM Kenalog (triamcinolone), IV Solu-Medrol (methylprednisolone)
oral prednisone
moderately potent systemic corticosteroid
