Name the 5 examples of corticosteroids on the PPE drugs list
- Hydrocortisone (oral or topical)
- Betamethasone (topical)
From which chemical is cortisol produced?
Where does this conversion occur?
Give some general physiological actions of glucocorticoids
- Redistribution of fat
Give some features of a low glucocorticoid state
- Weight loss
Give some features of a high glucocorticoid state
- Weight gain
- Increased appetite
What is steroid receptor homology?
Similar structure of glucocorticoids mean that in excess they will also bind to mineralocorticoids - exert some mineralocorticoid action such as increased Na+ reabsorption
Which pharmacological corticosteroid is good for replacing aldosterone due to its large effect at mineralocorticoid receptors compared to GC receptors?
Briefly outline the mechanism of action of corticosteroids at the molecular/cellular level
- Cross cell membrane as lipophilic
- Bind to cytosolic receptors - complex translocates to nucleus where it binds with glucocorticoid response element
- Bound GRE then modulates transcription of various genes - both stim and inhib:
- Trans-activation = stimulation of protein synthesis of anti-inflam proteins
- Trans-repression = inhibition of protein synth of inflam proteins
Outline corticosteroids’ mechanism of action in terms of effects on the immune system
- Inhibition of B and T cell responses
- Inhibition of nuclear factor kappa B
- Reduced transcription of cytokines
Give some examples of use of corticosteroids
- Inflammatory disease
- Adrenal insufficiency
What is Dexamethasone used for?
Diagnosis of Cushing’s syndrome
How could corticosteroids be useful for pregnant women?
Reduce risk of respiratory distress syndrome in preterm babies - stimulate development of type II pneumocytes - surfactant production
List some ADRs of corticosteroids
- Peptic ulcers
- Increased risk of infection
- Impaired growth
- Cushingoid features
- Cross-over with MC - fluid retention
Why shouldn’t you suddenly stop long-term corticosteroids?
Adrenal suppression - can’t make own cortisol - can have hypoadrenal crisis