7146614
Description
Flashcards by Andrew Street, updated more than 1 year ago
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Created by Andrew Street
almost 8 years ago
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| Question | Answer |
| Give eg's of & indications for systemic corticosteroids. | eg's: prednisolone, hydrocortisone, dexamethasone Indications: • Allergic or inflammatory disorders • Autoimmune DS - eg IBD, inflammatory arthritis • Rx of some CA's - as part of chemotherapy or to reduce tumour-associated swelling • Hormone replacement in adrenal insufficiency or hypopituitarism |
| MOA of systemic corticosteroids. | These corticosteroids exert mainly glucocorticoid effects. They bind to cytosolic glucocorticoid receptors, which then translocate to the nucleus & bind to glucocorticoid-response elements, which regulate gene expression. Corticosteroids are most commonly prescribed to modify the immune response. They upregulate anti-inflammatory genes & downregulate pro-inflammatory genes (e.g. cytokines, tumour necrosis factor alpha). Direct actions on inflammatory cells include suppression of circulating monocytes & eosinophils. Their metabolic effects include ^gluconeogenesis from ^circulating amino & fatty acids, released by catabolism (breakdown) of muscle & fat. These drugs also have mineralocorticoid effects, stimulating Na+ & water retention & K+ excretion in the renal tubule. |
| SE's of systemic corticosteroids. | • Immunosuppression - ^risk of infxn • Metabolic effects - DM, osteoporosis. ^catabolism leads to muscle weakness, skin thinning, easy bruising, gastritis • Mood & behavioural changes • Mineralocorticoid actions - HT, hypokalaemia, oedema • Adrenal atrophy - if corticosteroids are suddenly withdrawn after prolonged Rx this can lead to Addisonian crisis • Sx of chronic glucocorticoid deficiency that occur during Rx withdrawal include fatigue, weight loss & arthralgia (severe P in a joint without swelling or signs of arthritis) |
| CI's, cautions, & important interactions of systemic corticosteroids. | CI's: • None Cautions: • People with infxn • Children - can suppress growth Important interactions: Corticosteroids ^the risk of peptic ulceration & GI bleeding when used with NSAIDs & enhance hypokalaemia in pt's taking β2-agonists, theophylline, loop or thiazide diuretics. Their efficacy may be reduced by cytochrome P450 inducers (e.g. phenytoin, carbamazepine, rifampicin). Corticosteroids reduce the immune response to vaccines. |
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