L35- Steroid Pharmacology (synthetic corticosteroids) Flashcards Preview

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Flashcards in L35- Steroid Pharmacology (synthetic corticosteroids) Deck (18)
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1

list the types of uses for corticosteroids for adrenocortical insufficiency

-chronic
-acute
-undiagnosed acute attack

2

Addison's disease:
-(1) main Sxs
-(2) Tx, including (3) as main precaution

1- weakness, fatigue, weight loss, hypotension, hyperpigmentation, inability to maintain fasting glucose

2- long-term (chronic) oral hydrocortisone (inc dose during stress) + fludrocortisone

3- do not give glucocorticoid w/o salt retaining activity

3

describe acute use of corticosteroids in adrenocortical insufficiency (for what, and what is used)

-for life threatening shock, infection, trauma

Large amounts parenteral corticosteroids + fluid and electrolyte correction
-administer salt retaining hormones once hydrocortisone levels are reduced (~5 days)

4

describe corticosteroid use in undiagnosed acute attack of adrenocortical insufficiency

dexamethasone (avoid interference with testing cortisol levels)

fluid / electrolyte replacement

5

list the adrenocortical hypo/hyper-function disorders requiring corticosteroids

Hypofunction:
-CAH (congenital adrenal hyperplasia)

Hyperfunction:
-Cushing's syndrome / disease
-aldosteronism

6

CAH Tx

glucocorticoids --> ACTH suppression
1) treat initially as acute adrenal crisis
2) once stabilized --> oral hydrocortisone / prednisone + fludrocortisone

protect fetus in high risk pregnancies with dexamethasone

7

describe Tx of Cushing's disease / syndrome

(excess glucocorticoids)
1) primary: via bilateral adrenal hyperplasia --> tumor removal, uni/bi-lateral adrenal ressection

2) secondary: ACTH pituitary adenoma --> tumor removal, irradiation of pituitary

**must receive high doses of cortisol before / after surgery (tapered dose to prevent withdrawal)

8

Aldosteronism:
-(1) main cause
-(2) Sxs
-(3) Dx drug
-(4) Tx drug

1- (primary) adrenal tumor (maybe malignant)

2- hypokalemia, alkalosis, hypernatremia

3- spironolactone
4- spironolactone

9

describe purpose of dexamethasone suppression test

Cushings's disease:
-dexamethasone suppresses cortsol release
-must be pituitary dependent: no ectopic ACTH, corticol or adrenal tumor

10

describe possible corticosteroid treatments of a fetus

i) premature delivery is expected
ii) large dose glucocorticoids
iii) reduced incidences of respiratory syndrome

given IM- usually dexamethasone

11

list the immunologically related non-adrenal disorder uses of corticosteroids

Many inflammatory conditions: IBD, asthma, collagen vascular disorders (RA), ocular diseases (uveitis, optic neuritis, exophthalmos)

Allergic reactions: contact dermatitis, urticaria

Organ transplant rejection

Hodgkin's lymphoma [prednisone]

12

list the uses of corticosteroids associated with abnormalities of the blood (content, amount, ect.)

-hematological disorders: anemia, leukemia

-hypercalcemia

-cerebral edema [dexamethasone]

-idiopathic orthostatic hypotension [fludrocortisone]

13

corticosteroid use:
-prophylatically in (1) Tx
-(2) organ besides adrenal gland
-(3) specific altitude sickness

1- CINV (chemotherapy induced vomiting)

2- renal disorders -- nephrotic syndromes

3- mountain sickness (reverse alkalosis)

14

what are the main guidelines for corticosteroid treatment

-short term use --> few serious AEs

-best to use short or intermediate acting steroids

-long term use does have predictable toxicity

15

Corticosteroid AEs

-metabolic --> cushing's (DM, muscle wasting, osteoporosis)
-peptic ulcers
-hidden infections
-myopathy (long-acting)

-nausea, dizziness, weight loss
-CNS: euphoria, psychosis, depression
-inc intraocular pressure (glaucoma), posterior subcapsular cataracts
-Na / fluid retention, hypokalemia
-growth retardation
-adrenal suppression (atrophy)

16

describe techniques to minimize corticosteroid toxicity

-local application
-low dose, taper dose, alternate day dosing

-additional stress doses during serious illness or prior to surgery

-K+ supplements, Ca++/vitD supplements

17

list the main warnings with steroid use

-peptic ulcers
-HD or HTN w/ HF
-TB, VZV
-psychoses
-DM
-osteoporosis
-glaucoma

18

recommendations for stopping corticosteroid therapy

Abrupt stop --> withdrawal --> acute adrenal insufficiency

-taper dose down
-monitor closely