Chapter 11 - Corticosteroids

Question 1

When would you use an intranasal aerosol corticosteroid?

Answer 1

Management of seasonal and perennial allergies and nonallergic rhinitis

Question 2

What is the name of the group of chemicals released by the adrenal cortex?

Answer 2

Adrenal cortical hormones

Question 3

What chemical does the outer zone of the adrenal cortex release?

Answer 3

Corticosteroids

Question 4

What chemical does the inner zone of the adrenal cortex release?

Answer 4

Epinephrine

Question 5

What are the three types of corticosteroid hormones?

Answer 5

Glucocorticoids (cortisol)

Mineralorticoids (aldosterone)

sex hormones (androgens & estrogen)

Question 6

What does aldosterone do?

Answer 6

Regulates body water by increasing amount of sodium reabsorption in kidneys.

Question 7

What is another term for analogs of cortisol used in pulmonary disease?

Answer 7

Hydrocortisone

Question 8

What is the pathway for release and control of corticosteroids?

Answer 8

Hypothalamic-pituitary – adrenal axis

Question 9

What hormone in the body stimulates the adrenal cortex to secrete glucocorticoids?

Answer 9

Adenocorticotropic hormone

ACTH

Question 10

What are the main functions of glucocorticoids?

Answer 10

Metabolism of fats and carbohydrates

Glucose for body energy

lipolysis, redistribution of fat stores

breakdown of tissue protein

Question 11

What is steroid diabetes?

Answer 11

Excessive amounts of glucose in plasma due to overuse of steroid therapy

Question 12

What is HPA suppression?

Answer 12

Significant side effect of using corticosteroids

Adrenal suppression of endogenous glucocorticoids

Question 13

What does the body not do, with regards to endogenous and exogenous corticosteroids?

Answer 13

It cannot distinguish between exogenous and endogenous glucorticoids

Question 14

What is HPA suppression

Answer 14

When the body takes in too much exogenous cortisol that it doesn’t feel the need to create its own.

Question 15

What is a good way to minimize HPA suppression?

Answer 15

By using aerosolized glucocorticoids and localizing the treatment to the lungs

Question 16

What do you need to do when a patient is on oral corticosteroids and HPA suppression occurs?

Answer 16

We need to wean them off in order to let the body create its own again.

Question 17

What are the clinical indications for use orally inhaled corticosteroids?

Answer 17

• Maintenance, controlled therapy of chronic asthma, (identified as needing step 2 asthma care)
• can be used with systemic corticosteroids to reduce systemic dose or elimination for asthma control

Question 18

When are endogenous coritsol levels the highest?

Answer 18

In the morning

Question 19

What stops the production of endogenous glucocorticoids and ACTH?

Answer 19

High levels of cortisol in blood plasma because of the feedback mechanism.

Question 20

What is alternate days steroid therapy?

Answer 20

Giving steroid drugs that alternate days in the morning to avoid HPA system suppression

Question 21

What are the four major categories of inflammation activity?

Answer 21

Increased vascular permeability

Leukocytic infiltration

Phagocytosis

Mediator cascade

Question 22

What are the two most common inflammatory diseases of the airway?

Answer 22

Chronic bronchitis

Asthma

Question 23

What are the two major effector cells of the. Asthmatic inflammatory response?

Answer 23

Mast cells

Eocinophils

Question 24

What is shown to cause early phase asthmatic response in airways?

What does symptom does it cause?

Answer 24

Immunoglobulin E

Bronchospasm

Question 25

What happens during the late phase inflammatory response?

Answer 25

Submucosal edema Mucus Hyperreactivity

Question 26

When does the late phase inflammatory response occur?

Answer 26

6 - 8 hours after challenge

Question 27

What is a product of persistent shedding of epithelial cells in the respiratory system during inflammatory response?

Answer 27

Airway remodeling which can cause thickening in the basement membrane and increase epithelial damage enhancing inflammatory response in the future.

Question 28

How can you classify aerosolized glucocorticoids as a drug? And how was it absorbed by cells?

Answer 28

It is a topically active drug It is absorbed by lipid diffusion because it is lipid soluble

Question 29

What are the 3 general modes of action for glucocorticoids?

Answer 29

- Upregulation transcription of anti-inflammatory genes - suppression of factors that activate transcription of inflammatory genes - up regulate the expression of inhibitors of the inflammatory response

Question 30

What is the effect of glucocorticoids on white cell counts?

Answer 30

It increases over all white cell count like neutrophils

Question 31

A person with allergic asthma would have what kind of results on a white cell differential?

Answer 31

Higher than normal eosinophil count

Question 32

What is a benefit of using glucocorticoids for patients prescribed with beta adrenergic agents?

Answer 32

It can restore responsiveness to beta-adrenergic agents

Question 33

How do glucocorticoid drugs enhance receptor stimulation?

Answer 33

By increasing number, availability, and affinity of beta receptor cells.

Question 34

What is a good reason why you would take a corticosteroid and beta-adrenergic combo?

Answer 34

Because corticosteroids can prolong endogenous circulation of catecholamines prolonging the interaction of beta agonist.

Question 35

What are some hazards associated with systemic administration steroids?

Answer 35

F I M H H H ``` Fluid retention Immunosuppression Muscle wasting HPA suppression High glucose levels Hypertension ```

Question 36

What are 2 side effects of the local topical corticosteroid administration?

Answer 36

Oral thrush and dysphonia

Question 37

What is something you should tell the patient after taking an oral topical dose of corticosteroid?

Answer 37

Rinse their mouth

Question 38

How would you describe asthma as a disease?

Answer 38

It's a disease of inflammation leading to bronchial hyperresponsiveness

Question 39

What is the use of inhaled corticosteroids for treatment of asthma?

Answer 39

It is the first line of treatment Most effective long-term therapy for persistent asthma

Question 40

Can you use inhaled corticosteroids for acute severe asthma?

Answer 40

No, studies have shown that it is not useful due to no bronchodilator effect But is should be reconsidered

Question 41

What is the use of corticosteroids for COPD?

Answer 41

It can relieve symptoms but it has a little effect on FEV1

Question 42

What cell is predominantly involved in inflammation with COPD patients?

Answer 42

Neutrophils