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PHAR 253 > Corticosteroids > Flashcards

Corticosteroids Flashcards

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1
Q

where is steroid production?

A

adrenal glands

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2
Q

what do the adrenal glands do?

A

secrete mineralocorticoids, glucocorticoids, and sex hormones

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3
Q

what are the three zones of the adrenal gland cortex?

A

zona glomerulosa
zona fasciculata
zona reticularis

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4
Q

what hormones are produced in each zone of the cortex?

A

glomerulosa - aldosterone
fasciulata - cortisol
reticularis - testosterone

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5
Q

what are the primary functions of cortisol?

A

mediate the stress response
help regulate metabolism
help regulate the inflammatory response
help regulate the immune system

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6
Q

when is cortisol released?

A

in response to stress and it helps restore hormone levels when stress resolves

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7
Q

what regulates the production and secretion of cortisol?

A

hypothalamus pituitary adrenal(HPA) axis

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8
Q

what hormones are involved in the production and secretion of cortisol?

A

ACTH, CRH, and vasopressin

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9
Q

T or F: the production of cortisol is considered negative inhibition

A

True

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10
Q

what is the action of glucocorticoids?

A

suppress inflammatory and immunological responses

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11
Q

what is the MOA of an anti-inflammatory?

A

(impeding each step of the inflammatory process)
altering cytokine release
blocking increased capillary permeability
causing less vasoactive substance release
inhibiting leukocyte and macrophage migration/adhesion
interfering with phagocytosis

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12
Q

what is the immunosuppressive MOA?

A

altering the cell function of specific genes
affecting the function of WBCs
inhibiting T-cell activation
inhibiting IL’s, cytokines, gamma-interferon, and TNF-alfa synthesis

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13
Q

what are some of the other corticosteroid actions?

A

anti-mitotic activity
anti-tumour effects
anti-emetic effects

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14
Q

corticosteroid dosage forms

A

local - otic, ophthalmic, inhaled, topical
systemic agents - injectables, oral

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15
Q

how are otic/ophthalmic corticosteroids available?

A

drops, ointments, emulsions, intravitreal implants

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16
Q

what are ophthalmic/otic corticosteroids used for?

A

redness, itching, swelling, pain

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17
Q

what are some potential issues with ophthalmic/otic drops?

A

correct delivery technique
not getting drop into eye

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18
Q

uses for nasal inhaled corticosteroids

A

rhinitis, polyps, sinusitis

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19
Q

issues with topical nasal inhaled corticosteroids

A

installation technique

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20
Q

what are the metered dose inhalers?

A

fluticasone
beclomethasone
triamcinolone
ciclesonide
fluticasone propionate

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21
Q

what are the dry powders for inhalation?

A

budesonide
fluticasone
mometasone

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22
Q

pros of dry powders for inhalation

A

actuation, portable, show remaining doses

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23
Q

cons of dry powders for inhalation

A

powder deposition in mouth
requires good lung function

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24
Q

what are the types of inhaled corticosteroids?

A

nasal
metered-dose inhalers
dry powders for inhalation
combo products
solutions for inhalation (nebulizers)

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25
what is the drug for nebulizers?
budesonide
26
pros of nebulizers
reasonable lung delivery when cannot generate sufficient flow rate easy for infants and young children
27
cons of nebulizers
time consuming expensive non-portable equipment false-sense of superiority
28
what are the topical corticosteroid dosage forms?
lotions creams gels ointments enemas rectal ointments suppositories rectal foams
29
what is the effectiveness of topical corticosteroids based on?
potency dosage form concentration formulation application technique site skin condition
30
what are the injectable corticosteroids?
intravenous intramuscular intralesional intra-articular
31
intravenous drugs
hydrocortisone methylprednisolone
32
intramuscular drugs
betamethasone acetate/sodium phosphate dexamethasone sodium phosphate methylprednisolone triamcinolone
33
intralesional drugs
triamcinolone acetonide
34
intra-articular drugs
triamcinolone betamethasone methylprednisolone
35
when is IV used
when a faster onset or high dose is required
36
what is the usual site for intra-articular?
hip, knee, ankle, shoulder, elbow, wrist
37
how often can a joint be injected?
no more then 3-4x per year
38
how are oral corticosteroids absorbed?
rapidly and completely from the gut
39
what are the oral corticosteroid tablet drugs?
betamethasone cortisone dexamethasone hydrocortisone methylprednisolone prednisone triamcinolone
40
what drug is the oral solution corticosteroid?
prednisolone
41
what are physiologic doses used for?
to replace deficiencies ie. the amount of cortisol excreted by the adrenal cortex/day
42
what does of prednisone is equivalent to the amount of cortisol we produce in a day?
~5mg
43
how much cortisol do we produce per day?
10-20mg
44
what are pharmacologic doses used for?
to treat disease states and provide supportive therapy
45
what is the dosing for prednisone?
usually 0.5-1mg/day moderate dose: 0.5mg/kg/day high dose: 1-3mg/kg/day massive dose: 15-30mg/kg/day
46
REVIEW CORTICOSTEROID COMPARISONS - SLIDE 35
47
what are the short acting oral corticosteroids?
cortisone hydrocortisone 8-12 hours
48
what are the intermediate acting oral corticosteroids?
prednisone prednisolone methylprednisolone triamcinolone 12-36 hours
49
what are the long acting oral cotricosteroids?
dexamethasone betamethasone 36-72 hours
50
what are the AE's of ophthalmic corticosteroids?
stinging redness tears burning secondary infection catarax glaucoma
51
what are the AE's of oral inhalation corticosteroids?
thrush hoarseness dry mouth dysphoria difficulty swallowing
52
what are the AE's of nasal corticosteroids?
rhinorrhea burning sneezing bloody nose
53
what are the AE's of topical corticosteroids?
pretty well tolerated but.. burning irritation skin atrophy tachyphylaxis telangiectasia
54
what are some systemic complications of corticosteroids?
insomnia thinning of skin increased abdominal fat poor wound healing redistribution of fat nausea moon face
55
are CNS effects of corticosteroids dose related?
yes
56
what are the CNS effects of corticosteroids?
euphoria insomnia restlessness memory impairment can later become: - depression - mania - psychosis
57
what can increase when using ophthalmic corticosteroids?
IOP
58
what are risk factors for cataracts?
daily dose cumulative dose duration age increased risk with oral prednisone >15mg/d x 1 year
59
risk factors of glaucoma
pre-existing primary open angle glaucoma (POAG) diabetes fanilt history rheumatoid arthritis
60
gastrointestinal AE's of corticosteroids
GI upset - take with food dyspepsia increased risk of peptic ulcer disease when used in conjunction with NSAIDs
61
endocrine AE's of corticosteroids
increase blood glucose - normally mild sodium/water retention increased appetite growth retardation
62
what will corticosteroids with greater mineralocorticoid activity do?
more likely to cause fluid retention and elevate BP
63
why do CS's cause growth retardation?
decrease osteoblasts and GH secretion competitively inhibiting insulin receptors more pronounced with oral therapy
64
what is the HPA-axis?
a connection between the brain and adrenal glands the body's main stress system it releases cortisol to activate a response to stress
65
what is the diurnal cycle?
the release of cortisol throughout the day. endogenous levels of cortisol highest at 7-8am and decreases throughout the day
66
when will cortisol release be increased?
during periods of stress - illness, stress, surgery
67
what kind of "control" is the HPA-axis under?
negative feedback control by endogenous cortisol
68
what happens when exogenous corticosteroids are administered?
they cause negative feedback of CRH and ACTH resulting in suppression of the HPA-axis
69
if HPA axis suppression is present, what will happen is the steroids are abruptly stopped or if the patient becomes severely ill?
hypotension hypoglycaemia flu-like symptoms weight loss confusion
70
what factors may predict the occurrence of HPA-axis suppression?
dose type of steroid interval route duration time of administration
71
when is screening for HPA-axis suppression recommended?
taking oral CS's for >2 consecutive weeks or > 3 cumulative weeks in previous 6 months
72
what test is performed to determine HPA-axis suppression/recovery?
a blood test: SST (short synacthen test)
73
which dosage form has the highest risk of adrenal insufficiency?
oral > intra-articular > nasal
74
why do CS's impair wound healing?
they can impair antibodies and phagocytosis
75
what effects do corticosteroids have on bone?
protein catabolism osteoblast inhibition GH inhibition decrease Ca absorption decrease renal calcium reabsorption 30-50% will develop osteoporosis with chronic tx
76
what are the long term SE's in kids?
weight gain growth retardation cushingoid features infection - most serious
77
short course uses of CS's in kids
croup acute asthma
78
short course SE's of CS's in kids
vomiting behavioural changes sleep disturbances
79
when were CS's used in COVID and what drug?
for hospitalized patients requiring oxygen dexamethasone 6mg OD for up to 10 days
80
what are the dosing guidelines for corticosteroids?
NO SET GUIDELINES initial dosing: OD or BID maintenance dosing: OD
81
how do you taper lower then 5mg or prednisone?
may see conversion to 20mg HC and then taper further
82
when might you see EOD dosing?
chronic administration necessary children requiring maintenance dosing
83
how can you change to EOD dosing?
1. determine MED 2. EOD dose is 2.5-3x the MED 3. alternate the new calculated dose with MED 4. taper the MED by 5mg/week until removed 5. taper current dose by 5mg/week to the MED
84
what is steroid pulse therapy?
administration of short term, high dose, IV or PO steroids in various situations where rapid remission of serious conditions is desired
85
advantages to steroid pulse therapy
more rapid control of condition help avoid AE's by avoiding prolonged steroid therapy
86
disadvantages to steroid pulse therapy
certain adverse effects may be more likely and significant - hypertension - infection - seizure - psychosis

PHAR 253 (8 decks)

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