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Flashcards in Corticosteroids Deck (53):
1

What are the 3 different steroid hormones

Glucocorticoids, mineralcorticoids, sex steroids

2

Glucocorticoids

essential during stress, down regulates immune ststerm activity

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Mineralcorticoids

essential for liffe, regulate Na/K levels

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Sex steroids

androgens, estrogens, progestogens

5

What are corticosteroids synthesized from?

cholesterol within the adrenal cortex

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What are most steroidgenic rxns catalyzed by

enzymes in the cytochrome P450 family

7

What are the physiological actions of glucocorticoids

metabolic effects

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what are the pharmocological effects of glucocorticoids

anti-inflammatory, immunosuppressive and anti anaphylaxis, anti-shock, hematologic

9

What are the adverse effects of glucocorrticoids

GI, CNS exciting effects

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What are the carb metabolism effects of corticosteroids

inc gluconeogenesis, dec peripheral utilization of glucose, inc glycogen deposition in liver

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what are the protein metabolism effects of corticosteroids

breakdown of protein, mobilization of amino acid from periphery, negative nitrogen balance

12

Effects of carb and protein metabolism results in

diabetes like state state resistant to insulin, increased urea production, wasting of muscle lympholysis, thinning of skin

13

Effects of fat metabolism

increased lipolysis, decreased lipogenesis, inc breakdown of TGA, redistribution of fat- moon face

14

effects on electrolyes and H2O

enhanced Na reabsorption from the distal tubules of the kidney, will lead to fluid retention, an association inc in urinary excretion of K and H+, edema and hypertension common

15

What is the effect on anti-anaphylaxis

inhibits histamine release by basophils/mast cell

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Antishock effects

dec inflammatory factors release, inc body resistance to bacterial endotoxin, permissive role as a vasopressor (effects angotensin), inc myocardial contractibility

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Hematologic effects

stimulates hematopoiesis in bone marrow, RBC inc, Hgb inc, PLT inc

18

What do steroids do to the GI

increase gastric acid, increase pepsin

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What do steroids do to the CNS

euphoria, can cause seizures at high doses, insomnia but rare

20

Symptoms of addison's disease

fatigue, orthostatic hypotension, wt loss, changes in mood, arthralgias, hyperpigmentation

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Lab abnormalities of addison disease

hyponatremia, hyperkalemia, hypercalcemia, hypoglycemia, eosinophilia, lymphocytosis, metabolic acidosis

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What is treatment for addisons

replace cortisol with hypdocortisone or prednisone, replace aldosterone with fludocortisone

23

What is a test for cushings

dexamethasone suppresion test

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Treatment for cushings

taper and stop corticosteroids, remove tumore if needed, ketoconazole, mifepristone

25

Injectable steroids

betamethasone, dexamethosone, hydrocortisone, methylprednisolone, prednisolone, triamcinolone

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Oral steroids

betamethasone, fludrocortisone, methylprednisolone, prednisolone, prednisone

27

Inhaled steroids

advair, symbicort, azmacort, asmanex twisthaler, flovent, aerobid, pulmicort, QVAR

28

What are uses of hydrocortisone

antiinflammatory, replacement, shock, status asmaticus, ulcerativve colitis, crohns, thyroid storm

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Dosage of hydrocortisone

100 mg IV TID-QID, 20 mg PO daily, rapid but short acting

30

Predisone/Predisolone uses

allergy, asthma, COPD, autoimmune, inflammation, malignancy

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What is DOC steroid for peds

prednisone

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Dosage of prednison

Chronic- 5-20 mg PO daily, if acute must taper 60 mg TID down to 10 mg PO TID

33

Methylprednisolone uses

allergy, antiinflammatory, asthma, COPD, immunosuppressive, pulse therapy in non responsive RA, renal transplant

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What is potency and selectivity of methylprednisolone

more potent, GC selective

35

Dosage of methylprednisolone

IV- 125 mg QID- aggressive; 60 mg TID middle; 40 mg BID low; can go up to 250 mg QID

36

Triamcinolone use

arthritis injection, dermatoses, hay fever, MS

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What is potency and selectivity of triamcinolone

potent and GC selective

38

Dexamethosone uses

antiemetic, cerebral edema, cushings, dexamethasone suppression test, MS, inflammayion, allergy, physiological replacement, shock

39

Pearls of dexamthasone

very potent, highly selective GC, causes HPA suppression

40

Betamethasone uses

bursitis, dermatologic, MS, peritendinitis, tenosynovitis, RA OA

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Betamehtasone PEARL

very potent selective GC

42

Fludrocortisone use

congenital adrenal hyperplasia, orthostatic hypotension, replacement for Addison's

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Pearl of fludrocortisone

potent MC, some GC, dont use for inflammation or immunosuppression

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what renal diseases can steroids treat

nephrotic syndrome in children, renal disease ssecondary to SLE, renal sarcoidosis, glomerulonephritis

45

What other immunosuppressants are steroids combined with for organ transplant

cyclosporine, azathioprine

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What infectious dissease can steroids treat

AIDs and pneumocystis carinii pneumonia, haemophilus influenza meningitis, tubercular meningitis, sepsis

47

Steroids are essential for what malignancy

ALL, hodgkin's or other lymphoma, hormone responsive breast cancer, can provide symptomatic relief in other CA

48

Other uses of steroids

acute mountain sickness, aspiration pneu, pulmonary edema, cerebral edema, thyroid storm, idiopathic thrombocytopenic purpura

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Short term admin ADRs

insomnia, inc appetite, wt gain, behavioral, peptic ulcer

50

Steroid withdrawal

weakness, fatigue anorexia, arthralgias, wt loss, NVD, hypoglycemia, fainting, hypotension, shock, death

51

Warnings of steroids

CVD, DM, peptic ulcer, hepatic impairment, MI, osteoporosis, seizure disorder, glaucoma, infection, HTN

52

Contraindication of steroids

systemic fungal infection

53

Long term steroid ADR

CVD, metabolc, endocrine, skeletal, GI, hypokalemia, neuropsychiatric, immune function