Glucocorticosteroids

Question 1

Glucocorticosteroids, mineralocorticoids, and sex hormones precursors are all what?

Answer 1

Adrenocortical hormones (steroid molecules produced + released by adrenal cortex)

Question 2

Functions of this drug include carbohydrate/lipid/protein metabolism, cardiovascular fx, and immune fx/inflammation.

Answer 2

Glucocorticosteroids

Question 3

Which glucocorticosteroid has the greatest effect?

Answer 3

Hydrocortisone (b/c its just the exogenous form of cortisol, exactly the same structure)

Question 4

What are the short acting glucocorticosteroids?

Answer 4

1. Hydrocortisone (cortisol)
2. Cortisone
3. Fludrocortisone (mineralocorticoid)

Question 5

What are the intermediate acting glucocorticosteroids?

Answer 5

1. Methylprednisolone
2. Prednisone
3. Triamcinolone

Question 6

What are the long acting glucocorticosteroids?

Answer 6

1. Betamethasone
2. Dexamethasone

Question 7

How do glucocorticoids work?

Answer 7

Anti-inflammatory/immunosuppressive but also cause leukocytosis (increase WBC count) 2/2 demargination

Question 8

What causes these effects: carb/lipid/protein metabolism, stimulate gluconeogenesis, promotes glucose formation, anti-insulin effect, decrease glucose uptake by cells, increase lipolysis/protein lysis, decrease protein synthesis?

Answer 8

Glucocorticosteroids

Question 9

What effects do glucocorticosteroids have on bone?

Answer 9

• Decrease Ca absorption from intestine
• Increase mobilization of Ca from bone
• Increase risk of osteoporosis - recommend Ca (1000-1200 mg/day) + VD (800-2000 IU/day)

Question 10

What effects do glucocorticosteroids have on peptic ulceration?

Answer 10

• Increase gastric output
• Decrease synthesis of mucopolysaccharides (glycosaminoglycans)
• Increase risk w/ NSAID use, total doses > 1 gm Prednisone + > 30 day DOT

Question 11

What CNS effects do glucocorticosteroids have?

Answer 11

• Euphoria, insomnia, psychosis -> Depression
• Magnify existing conditions
• Steroid psychosis

Question 12

What effects do glucocorticosteroids have on edema + HT?

Answer 12

Na + H2O retention (mineralocorticoids)

• Moon face (Cushings)
• Buffalo hump (due to fat redistribution)

Question 13

What effects do glucocorticosteroids have on growth?

Answer 13

Suppression in children due to HPA inhibition

Question 14

Cataract formation, glaucoma, increase in hair growth, weight gain, acne…are all what?

Answer 14

Adverse effects of glucocorticoids

Question 15

What are monitoring parameters for use of glucocorticosteroids?

Answer 15

• Complete blood counts
• Electrolytes
• Plasma glucose
• Lipid panels
• Bone scan
• Monitor pts for Na retention, edema + HT
• Monitor pt peptic ulcer disease, osteoporosis + hidden infx

Question 16

What are inhaled steroids used for?

Answer 16

Asthma + COPD

• must rinse mouth after using to prevent candida (thrush)

Question 17

What are intranasal steroids used for?

Answer 17

Allergic rhinitis, non-allergic rhinitis, nasal polyps

Question 18

What are opthalmic steroids used for?

Answer 18

Post-op inflammation, conjunctivitis, corneal injuries

Question 19

What are rectal steroids used for?

Answer 19

Hemorrhoids + ulcerative colitis

Question 20

What are shampoo steroids used for?

Answer 20

Seborrheic dermatitis (Fluocinolone)

Question 21

Betamethasone, Budesonide, Cortisone acetate, Dexamethasone, Hydrocortisone, Methylprednisolone, Prednisolone, Prednisone, and Triamcinolone are all what?

Answer 21

Glucocorticosteroids that can be given systemically (PO or paraenterally)

Question 22

What are the high potency topical steroids?

Answer 22

Amcinonide 0.1%

Betamethasone diprop, augmented 0.05% cream

Betamethasone valerate 0.1% oint

Desoximetasone 0.05% gel, 0.25% cream, oint

Fluocinodine 0.05%

Halcinonide 0.1%

Triamcinolone acetonide 0.5%

Question 23

What can high potency topical steroids induce?

Answer 23

Majocchi granuloma (deep tissue tinea infx)

Question 24

What are the very high potency topical lotions?

Answer 24

Betamethasone diprop augmented 0.05% oint

Clobetasol propionnate 0.05%

Diflorasone diacetate 0.05%

Halobetasol propionate 0.05%

Question 25

What is the max amount of time a very high potency topical steroid should be used?

Answer 25

3 wks

Question 26

How is potency of topical steroids determined?

Answer 26

Extent to which agent causes cutaneous vasoconstriction "blanching effect"

Question 27

What should be used for tx of skin diseases characterized by inflamm, hyperproliferation, and/or immunologic phenomenon, and also burns + pruritus (i.e. allergic contact dermatitis, eczema, psoriasis)?

Answer 27

Topical steroids

Question 28

What is important to consider before tx w/ steroids?

Answer 28

Get an accurate dx by skin scraping/potassium hydroxide tests (tells you steroid vs. antifungal; steroids can exacerbate a fungal infx)

Question 29

What is the most common SE of topical steroids?

Answer 29

Atropy of epidermis/dermis

Question 30

Acneiform eruption, folliculitis, rosacea, atrophy, skin fragility delayed wound healing, purpura, erythema, hypopigmentation, masking/aggravation of dermatophyte infx, secondary infx or aggravation of exisiting infx, and contact dermatitis are all what?

Answer 30

ADR for topical steroids

Question 31

Which preparation of topical steroids is used for treating dry/thick, hyper-keratotic lesions, provides good occlusion (which improves absorption), and should not be used on hairy/intertriginous areas (may cause maceration/folliculitis)?

Answer 31

Ointment

Question 32

Which preparation of topical steroids is useful for acute exudative inflamm (b/c drying effect), can be used on intertriginous areas (groin, gluteal cleft, axilla), has good lubrication, is cosmetically appealing, may contain preservatives (irritation, stinging + allergic rxn), and is less potent than ointments?

Answer 32

Creams

Question 33

Which preparation of topical steroids is the least greasy/occlusive, may contain alcohol (drying effect on oozing lesion), is useful for hairy areas, and is beneficial for exudative inflamm (poison ivy)?

Answer 33

Lotions -\> contain alcohol Gels -\> poison ivy

Question 34

Which is the most expensive preparation out of the 3 topical steroids: foams, mousses, shampoos?

Answer 34

Foams