1
Q
What are corticoids? (2)
A
- steroid hormones
- synthesized in the adrenal cortex
2
Q
Steroids are a derivative of…?
A
cholesterol
3
Q
What steroid is produced in the ovaries? (2)
A
estrogen + progesterone
4
Q
What steroid is produced in the testicles
A
androgens
5
Q
What steroid is produced in the adrenal glands?
A
corticoids
6
Q
What is the mineralocorticoid?
A
aldosterone
7
Q
What is the function of aldosterone?
A
electrolyte metabolism (reabsportion) ex. water, sodium
8
Q
What is the glucocorticoid hormone?
A
CORTISOL-HYDROCORTISONE
9
Q
What is the function of cortisol? (4)
A
intermediate metabolism
- gluconeogenesis
- lipolysis
- proteolysis
10
Q
What is the androgenic steroid?
A
androsterone
11
Q
What is the function of androsterone?
A
virilizing effect (development of male characterisitics)
12
Q
Describe the hypothalamic-pituitary-adrenal axis (3)
A
hypothalamus –> hypophysis –> adrenal glands
13
Q
Describe the hypothalamic-pituitary-adrenal axis’s hormones (4)
A
CRH –> ACTH –> cortisol
Each hormone produced has a negative feedback on the one that produced it
14
Q
What main matabolism effects do glucocoticoids have? (3)
A
- release of glucose
- decreased formation of proteins and fats
15
Q
What are the other roles of glucocorticoids? (5)
A
- adaptation to stress
- anti-inflam.
- suppress immune system
- maintaining blood pressure
- bone density
16
Q
Do steroids have more side effects than NSAIDs?
A
yes
17
Q
Are steroids a more potent anti-inflam than NSAIDs?
A
yes
18
Q
Are corticoid drugs natural or synthetic?
A
both
19
Q
What is the advantage of synthetic corticoids? (3)
A
- metabolized slower in the liver
- therefore longer halflife
- more potent
20
Q
Rank the glucocorticoids in order of highest potency (4)
A
- dexamethasone
- methylprednisolone
- prednisone
- cortisol
21
Q
equivalent doses become ____ as the potency increases
A
smaller
22
Q
equivalent doses for corticoids use which drug as a reference?
A
cortisol - activity = 1
23
Q
What is the mechanism of action for corticoids?
A
-inhibition of phospholypase A2
24
Q
glucocorticoids effects? (3)
A
- anti-inflam
- immunosupressive
- inhibition effect of lymphoid tissue
25
Glucocorticoid mechanism of action?
phospholipase A2 inhibition
26
route of administration for glucocorticoids? (6)
- oral
- IV
- IM
- topical
- inhaled
- SC
27
What is the immunosuppresive effect with glucocorticoids? (2)
- medium dose: prevent antigen-Ab binding stopping release of mediators and cell damage
- High dose: reduces synthesis of Ab and antigen-Ab binding
28
What is the inhibition effect of lymphoid tissues with glucocorticoids?
- decreased clonal expansion of T&B cells
| - decreased action of T cells secreting cytokines
29
What are the 2 main glucocorticoid indications?
- endocrine replacement therapy
| - non endocrine diseases
30
Why are glucocorticoids used for endocrine replacement therapy?
Addison's disease
31
Why are glucocorticoids used for non-endocrine diseases? (6)
anti-inflam:
- rheumatic diseases
- idiopathic inflam diseases
- allergies(asthma, insect bites, urticaria)
Immunosuppressive
- autoimmune
- organ transplant (avoid rejection)
Neoplastic disease
- in combo with cytotoxic drugs to treat specific malignancies
ex. acute lymphocytic leukemia, hodkin's
32
What types of allergies do glucocorticoids treat? (3)
- asthma
- insect bites
- urticaria
33
What are glucocorticoids immunosuppressive effects used for? (2)
- auto-imune diseases
| - organ transplant (avoids rejection)
34
How are glucocorticoids used with neoplastic diseases? which? (3)
- in combo with cytotoxic drugs to treat specific malignancies
ex. acute lymphocytic leukemia, hodkin's
35
What is the glucocorticoid route of administration for rheumatic diseases?
oral
36
What are the rheumatic diseases? (2)
- rheumatoid arthiritis
- ankylosing spondylitis
- other severe acute arthritis
37
How do we treat ankylosing spondylitis? (2)
- glucocorticoids are second choice
| - use for shortest time and lowest possibile dose
38
What class of drugs treat bronchial asthma? whats the route of administration? (3)
- glucocorticoids
- inhaled
- IV
39
What drugs do we use for bronchial asthma? (4)
- Budesonide
- beclomethasone
- fluticasone
- IV glucocorticoids
40
When do we use IV glucocorticoids? (2)
- bronchial asthma (asthmatic crisis)
| - digestive inflammatory diseases
41
When do we use IV glucocorticoids for bronchial asthma
during asthmatic crisis
| -has side effects
42
What is the glucocorticoid route of administration for digestive inflam. diseases? (3)
- oral
- IV
- enema
43
What glucocorticoid is used for digestive inflam. diseases?
budesonide
44
What is the glucocorticoid route of administration for ocular inflammatory diseases?
topical
45
What ocular inflammatory diseases do we use glucocorticoids for? (3)
- allergic conjunctivitis
- scleritis
- uveitis
46
What is the glucocorticoid route of administration for skin diseases?(2)
- topical
| - general
47
What skin diseases do we use glucocorticoids for? (3)
- eczema
- psoriasis
- pemphigus
48
What allergic diseases do we use glucocorticoids for? (2)
- anaphylaxis
| - serum sickness
49
What autoimmune diseases do we use glucocorticoids for? (3)
- lupus erthematosus
- scleroderma
- vasculitis
50
Which glucocorticoids are used to treat leukemia and lymphoma? (2)
- prednisolone
| - deamethasone
51
What are the routes of administration for glucocorticoids locally (4)
- topic
- inhaled
- subcutaneous
- intraarticular
52
What are the routes of administration for glucocorticoids systemic (4)
- ORALLY
- INTRAMUSCULAR (irregular bioavailability) -INTRAVENOUS
- RECTAL (enemas)
53
Which glucocorticoids are used orally?
- Prednisone - intermediate action
| - Deflazacort - intermediate -Prednisolone
54
Steroids in dentistry used for: (8)
```
Stomatitis
Lichen planus
Desquamative gingivitis
Cheilitis (inflammation of the lips)
Traumatic ulcer
Pulpitis
Temporomandibular joint pain
Systemic disease oral lesions
```
55
Steroid contraindications in dentistry?
herpetic sores
56
Topical steroid contraindications?
skin infections
57
Which topical steroid do we use first?
-hydrocortisone
58
Glucocorticoid contraindications? (3)
Gastroduodenal ulcer
Osteoporosis
Psychosis
59
What are the adverse reactions with glucocorticoids and mineralocorticoids? (5)
- cortisol, prednisone and prednisolone produce mineralocorticoid effect
- Na+ and water retention by the kidney.
Results in:
- weight gain
- oedema
- hypertension
60
What are the adverse reactions with glucocorticoids mentally? (5)
- Moderate euphoria, feeling of well-being
- Insomnia
- depression
- memory impairment
- Acute psychosis
61
What are the adverse reactions with glucocorticoids and eyes? (3)
- cataracts
- intraocular hypertension
- glaucoma (genetically predisposed)
62
What are the adverse reactions with glucocorticoids and hormonal changes? (3)
- inhibition of growth >6months in children
| - women: menstrual disorders + amenorrhea
63
What are the adverse reactions with glucocorticoids and digestion? (2)
- alters gastric mucoa causing gastritis or peptic ulcer
| - acute pancreatitis
64
What adverse effect happens with postmenopausal women and glucocorticoids?
loss of bone mass
65
What are the adverse reactions with glucocorticoids and bones? (2)
- loss of bone mass
| - happens more in postmenopausal women
66
What are the adverse reactions with glucocorticoids and muscles? (2)
- loss of strength
| - weakness/atrophy
67
What is the iatrogenic adverse reactions with glucocorticoids
cushings disease
68
What are the adverse reactions with glucocorticoids and adrenal cortex? (2)
- hyperglycemia: steroid diabetes
| - hyperlipidemia
69
What are the adverse reactions with glucocorticoids and adrenal cortex? (2)
- atrophy
| - supression/inhibition of hypothalamic-pituitary-adrenal axis
70
What are the irreversible side effects of glucocorticoids? (3)
- osteoporosis
- in children- inhibition of growth
- eye disorders - cataracts
71
Most adverse effects for glucocorticoids... (2)
disappear after months or years of stopping treatment.
*some are irreversible
72
Describe adverse reactions with glucocorticoids treatment duration (2)
- short treatments (<15 days): none
| - long treatments (>2months): appear with doses above 5-10 mg prednisone/day
73
To maintain disease control, glucocorticoid treatment starts off....
high dose (ex. prednisone) and decreased slowly until lowest dose
