GLUCOCORTICOSTEROIDS Flashcards
adrenocorticol hormones
- define
- categories
- steroid molecules
- produced + released by adrenal cortex
3 categories
- glucocorticosteroids/glucocorticoids (cortisol)
- mineralocorticoids (aldosterone)
- sex hormone precursors
glucocorticoids
cortisol v. hydrocortisone
- cortisol is major glucocorticoid in humans
- hydrocortisone is pharmaceutic cortisol
glucocorticosteroids
- types
- physiologic effects it regulates
- short, intermed, long acting
regulates: - carb, lipid, protein metab
- CV function
- immune func + inflamm
short, intermed, long acting
- list names
short acting
- hydrocortisone, cortisone, fludrocortisone
intermed acting
- methylprednisone, prednisone, triamcinolone
long acting
- betamethasone, dexamethasone
therapuetic uses/indications
- asthma
- sarcoidosis (ocular, CNS, gladnular, myocardial, pulm involvement)
- adv pulm or extrapulm TB
- pericarditis
- inflamm
- adrenal insuff (addisons chronic + acute)
- cushings syndrome
therapeutic uses/indications contd.
- immunosuppression
- rheumatic + collagen d/o (arthritis, SLE, psoriasis)
- pre term labor (stim lung maturation in fetus)
- cerebral edema
- spinal cord injury
- cancer
how do glucocorticosteroids work
anti-inflamm + immunosuppressive properties
how do glucocorticosteroids work
- anti-inflamm process
anti-inflammatory actions
- DEC neutrophil migration (they reduce migration to injury site to dec inflamm)
- DEC prostglandin + leukotriene synthesis
- suppress T lymphs + cytokine production (by T helper cells)
- prevent mast cells, basophil,m eosinophils releasing immune mediators (histamine, PGs, leukotrienes)
immunosuppressive effects of glucocorticoids
- how does it affect WBC?
suppress immune function, but can paradoxically cause inc in WBC
- due to demargination–> detach WBC from vessel wall, causing it to appear as a higher count
NOT due to inc WBC production
carb, lipid, protein metab effects
- stim gluconeogenesis
- promote glucose formation
- anti-insulin effect
- dec gluc uptake by cells
- inc lipolysis
- inc protein lysis
- dec protein synth
adverse effects
- bone
- recommendation for these pts
- dec calcium absorp from intestine
- inc mobilization of calcium from bone
can cause osteoporosis (inc risk pts>50 yo, post menopause, restricted mobility)
- calcium (1000-1200mg/day) + vit D supplements (800-2000 IU/day)
adverse effects
- GI
peptic ulceration
- inc gastric output
- dec synth mucopolysaccharides
- inc risk w NSAID use, total doses >1 hm prednisone and >30 day duration of tx
adverse effects
- CNS
- changes in mood/behavior
- euphoria, insomnia, psychosis initially —> depression
- magnify existing conditions, unmask those not apparent
- STEROID PSYCHOSIS
adverse effects
- mineralocorticoid effects
- HPA suppression
- misc/other
edema and HTN
- Na + water retention
- moon face (cushings)
- buffalo hump (fat resdistribution in cushings)
HPA suppression
- growth suppression in children
OTHER
- cataract formation + glaucoma
- misc: inc hair growth, wt gain, acne
adverese effects
- HPA axis inhibition
- complications w withdrawal
high doses + prolonged periods (>2 weeks tx)
- suppress release of CRH in pituitary gland
- adrenal cortex stops secreting endogenous corticosteroids
- withdrawal if exogenous steroids abruptly discont
- MUST TAPER SLOWLY
monitoring labs + imaging, any potential ds?
- CBC
- electrolytes
- plasma glucose
- lipid panels
- bone scan
- monitor for sodium retention, edema, HTN
- monitor for PUD, osteoporosis, hidden infx
dosage forms
- inhalation
- intranasal
- ophthalmic
- rectal
- shampoo
- systemic (PO + IV)
- topical
inhaled steroids
- indications
- types
- important note
indications
- COPD and asthma
types
- beclomethasone
- budesonide
- flunisolide
- fluticasone
- triamcinolone
note
- must rinse mouth after using to prevent oral candida
intranasal
- indications
- types
indications
- allergic rhinitis, non-allergic rhinitis, nasal polyps
types
- beclomethasone
- budesonide
- flunisolide
- fluticasone
- mometasone furoate
- triamcinolone
ophthalmic
- indications
- types
indications
- post op inflamm, conjunctivitis, corneal injuries
types
- dexamethasone
- fluoromethalone
- loteprednol
- medrysone
- prenisolone
- rimexolone
rectal
- indications
- types
indications
- hemorrhoids, ulcerative colitis
types
- hydrocortisone
shampoo
- indication
- type
indication
- seborrheic dermatitis
type
- fluocinolone
systemic (PO or parenteral)
- types
- betamethasone
- budesonide
- cortisone acetate
- demathesone
- hydrocortisone
- methylprednisolone
- prenisolone
- prednisone
- triamcinolone
topicals
- indications
tx skin ds characterized by inflamm, hyperproliferation, and/or immunological phenomenon, also burns and pruiritis
- allergic contact dermatitis
- eczema
- psoriasis
