Steroids Flashcards
(35 cards)
What 3 chemicals are secreted by the adrenal cortex?
Minercorticoids, glucocorticoids, androgens
What 2 chemicals are secreted by the adrenal medulla?
Epi and NE
What is the principal steroid? How is its secreted regulated?
Hydrocortisone
Regulated by ACTH and CRF
What is the HPA axis?
Hypothalamus -> CRF -> Pituitary -> ACTH -> Adrenal Gland
T or F. Glucocorticoids work on receptors outside and inside nucleus.
T
Explain how steroids work.
Bind to receptors that have ‘genomic’ effects via DNA synthesis suppression/activation
Why would DNA synthesis have an effect on the cell?
It controls synthesis of pro-inflammatory chemicals - LTs, PGs, cytokines
Glucocorticoids are MESSY. Name 6 effects:
- Gluconeogenesis
- Catabolism
- Osteoporosis
- Delayed growth
- Fat deposition
- Reduced healing
- Suppressed allergic response and Ab production
What regimen of steroids do you need to worry about HPA suppression?
20 mg prednisone for 14 days
What happens if you do not taper steroids?
Acute adrenocortical insufficiency
What can you not forget to do for those on chronic steroids (achieving HPA suppression)?
stress dose 50-100 mg of HC IV
What is the average therapeutic daily dose of HC (endogenous)? prednisone?
10mg/d
2.5 pred
Topical and inhaled steroids typically do NOT achieve serum concentrations that cause HPA suppression. What is the exception?
Ritonavir
How do you test an intact HPA axis? How does it work?
Dexamethasone Suppression Test - D suppresses CRH, which should suppress cortisol levels. If cortisol levels do NOT lower, then there must be (1) an excess of ACTH from a pituitary problem or (2) excess cortisol from adrenal gland problem
How short/long-acting is Hydrocortisone? How is it available?
Short ~ 1 hr
PO, IV, OTC topical
HC is bound to CBG. At what time of the day are CBG levels highest and lowest?
Lowest in the AM
highest in the PM
What is the half life of prednisone? Is it lipid/water soluble?
1-3h, effects within 2-8 hrs
Lipid soluble - well absorbed in the gut
When should you administer prednisone?
AM
What is the IV formulation of prednisone? Does it make sense to use it in order to get faster effects?
Methylprednisolone
No (similar to warfarin)
What are 4 common AEs for prednisone?
Reduced gastric mucusa - peptic ulcer dz
depression and psychosis - hallucinations
weight gain - Na retention, increased appetite
hypokalema
What are 6 rarer AEs for prednisone?
avascular necrosis tendon rupture peptic ulcerations (esp w/ NSAIDS) cataracts menstrual DOs thromboembolism
What are some signs of immune suppression that present in those on steroids?
low grade temp
sore throat
mouth ulcerations that wont heal
oral candidiasis
Explain the difference between a high white count from steroid use and from an infection.
steroid - no left shift
infection - left shift
what is responsible for the high WBC count in those on steroids?
de-margination - concentrates the blood stream with WBCs
