Glucocorticoids

Question 1

Glucocorticoid effects

Answer 1

Inhibition of phospholipase enzyme, suppresses the arachidonic acid cascade

Question 2

Glucocorticoid physiological dose

Answer 2

Amount of glucocorticoid that would be produced naturally by the adrenal cortex

Question 3

Glucocorticoid pharmacological dose

Answer 3

Any dose in excess of the physiological dose

Question 4

NSAID: Inhibited pathways

Answer 4

COX-1, COX-2, LOX pathways

Question 5

Glucocorticoids: Immune system effects (4)

Answer 5

Reduces mast cells

Change in leukocyte numbers, reduces function

Suppresses cell-mediated immunity

Reduces other inflammatory mediators

Question 6

Glucocorticoid uses (2)

Answer 6

Control acute allergic reactions

Control some chronic inflammatory conditions

Question 7

Glucocorticoid: Anti-inflammatory dose potential side effects (4)

Answer 7

PU/PD - most common

Polyphagia

Delayed wound healing

Suppression of the hypothalamus-pituitary-adrenal-axis

Question 8

Glucocorticoids: High dose and long term tx potential side effects (3)

Answer 8

Gastric ulcers

Opportunistic infections

Iatrogenic hyperadrenocorticism

Question 9

Glucocorticoids: Contraindications (5)

Answer 9

Pregnancy - teratogenic, risk of abortion

Diabetes mellitus - promotes tissue insulin resistance

Systemic infections

Corneal ulcers

Concurrent NSAID therapy

Question 10

Glucocorticoid administration: avoiding adverse effects

Answer 10

Use the lowest effective dose for the shortlist possible time

Oral tx is almost always tapered

Question 11

Glucocorticoid species differences: dogs (2)

Answer 11

More sensitive to side effects - pu/pd and polyphagia often happen at or below therapeutic doses

Highest risk for developing iatrogenic chushings syndrome

Question 12

Glucocorticoid species differences: cats (3)

Answer 12

Tend to be more resistant to side effects

Can trigger diabetes mellitus in predisposed pt

Can trigger CHF in pt with cardiac disease

Question 13

Glucocorticoid species differences: horses (2)

Answer 13

Relatively resistant to side effects

Small risk of laminitis

Question 14

Goucocorticoid species differences: ruminants (1)

Answer 14

Must be administered parenterally

Question 15

Glucocorticoid species differences: rabbits and guinea pigs (1)

Answer 15

Highly sensitive to even small doses via any administration, used cautiously or not at all

Question 16

Hydrocortisone: type, potency

Answer 16

Synthetic version of a naturally produced glucocorticoid

Potency of “1” used to compare other GCs

Question 17

Prednisone vs Prednisolone: metabolism, species differences

Answer 17

Prednisolone is the active form of Prednisone

Horses and cats require Prednisolone, poorly absorbe Prednisone

Question 18

Dexamethasone: potency, duration

Answer 18

Highest potency, highest risk of adverse effects

Longest duration, highest risk of HPA axis suppression

Question 19

Dexamethasone: administration (3), formulations

Answer 19

Tablets, injectable, ophthalmic topical

Two injectable dosage strengths, read labels and double check!

Question 20

Methylprednisolone sodium succinate (SoluMedrol): use, administration

Answer 20

Acute situations (anaphylactic shock, hypersensitivity reactions)

Water soluble IV injection

Question 21

Methylprednisolone acetate (DepoMedrol): administration

Answer 21

Lipid solution repository formulation, 1-6 weeks

Can still be affecting HPA axis after clinical effect has worn off

Question 22

Triamcinolone acetonide: administration (2)

Answer 22

Oral

Repository suspension

Can still be affecting HPA axis after clinical effect has worn off

Question 23

Betamethasone: administration, potency

Answer 23

Topical

Very potent

Question 24

Fluticasone: administration

Answer 24

Metered dose inhaler (MDI)

Requires species appropriate delivery device