coticosteriod Flashcards
(35 cards)
What are the Clinical Indications of ICS
asthma symptoms aren’t controlled
Where is Corticosteroids produced and example
adrenal cortex secretes corticosteroids:
–>glucocorticoids (cortisol)
adrenal medulla secretes catecholamines
What is the fxn of Glucocorticoids
- restoring metabolic demand to return to homeostasis due to stress
- elevated blood glucose
- gluconeogenisis
- ->from protein and fat storage
2.anti-inflammatory and immunosuppressant actions
- ↓ eosinophil and lymphocyte production
- Block release of cytokines (↓ T and B cell response)
- Stabilizes lysosome membranes
How is Endogenous Corticosteroids produced?
via hypothalamic-pituitary-adrenal (HPA) axis
- Stimulation of the hypothalamus –> release of CRF to anterior pitutary
- CRF stimulates secretion of ACTH in AP
- ACTH simulates the adrenal cortex to secrete glucocorticosteroids
- increase blood level of glucocorticosteroids will inhibit the HPA at the level of hypothalamus and anterior pituitary level
What is and the fxn of Mineralocorticoid
Aldosterone
- conserve sodium by increases renal reabsorption
- increased blood volume; fluid overload as side effect
what is adrenal suppression?
- when exogenous source of glucocorticoid increase body’s level and Inhibits the hypothalamus and pituitary glands
What is the diurnal Steroid Cycle?
body’s own production of corticosteroids follows a rhythmic, 24 hrs cycle
highest after 8 am
then 1 pm and 8 pm
What is the MOA of Corticosteroids?
Steroids diffuse into cells & bind to glucocorticoid receptors (GR) to produce anti-inflammatory action by:
- Inducing gene expression for anti-inflammatory proteins - lipocortin
- suppress gene expression for pro-inflammatory proteins
- Inhibit cytokine (interleukin) production responsible for recruitment and migration of inflammatory cells
What is Corticosteroids effect on WBC count
Demargination: depletion of neutrophil stores reduces their accumulation at inflammatory sites and in exudates
increase WBC count
Constriction of microvasculature to reduce leakage of cells and fluids into inflammatory sites
What is the effect of inflammation
Produces general symptoms of redness, swelling heat and pain via
- Increased vascular permeability
- ->increase Exudate in surrounding tissue - Leukocytic infiltration
- ->WBC’s invade in response to chemotaxis - Phagocytosis
- ->WBC’s & macrophages digest foreign matter in the lungs - Inflammatory mediator cascade
- ->histamine and arachidonic acid products are generated
how does steriod inhibit the prevention of arachidonic acid?
Steroids increase the synthesis of lipocortin, a phospholipase A2 inhibitor
as a result, this prevents arachidonic acid taking the leukotriene and prostaglandin pathway
–>lead to decrease inflammation and reduce hyper-responsiveness of airways
What is the result of Airway Inflammation
edema
mucous
increased microvascular permeability (leakage), bronchospasm
How to avoid side effect of ICS
Use of spacer, gargling/brushing teeth after
oral thrush from candida albicans
What are the side effect of systemic steroid
suppression of HPA axis immunosuppression osteoporosis cushingoid effects** diabetes due to hyperglycemia via gluconeogenesis
What is the cushingoid effects
- moon face” and weight gain from fluid retention
- ->lead to hypertension
- buffalo hump” from fat mobilization
- protein & muscle wasting due to catabolic effects of cortisol
- masculinization
What is the goal between system and inhaled corticosteriod
in lung disease–> switch from systemic to oral to reduce side effects
When to start switch
after more than 10 days of systemic steroids
there is adrenal insufficiency so
slow tapering allows HPA axis to begin to function normally
how to provide corticosteroid therapy?
give intermediate acting (12-36 hrs) steroid in am when body natural steroid levels are high
- skip steroids next day, so body can resume natural steroid production
What are the systemic short acting corticosteriod agents
Hydrocortisone(Solucortef)
Cortisone(Cortone)
What are the intermediate acting corticosteriod agents
Methylprednisolone(Solu-Medro IV) or (Depo-Medrol - IM)
Prednisone (Pediapred)
What are the long acting corticosteriod agents
Dexamethasone (Decadron
How long is short acting SCS?
8 - 12 hrs
how long is intermediate acting SCS ?
12 - 36 hrs
How long is long acting SCS?
36 -72hrs
