Podcast
Questions and Answers
What is the oral dose of prednisone for anti-inflammatory use initially?
What is the oral dose of prednisone for anti-inflammatory use initially?
Which of the following corticosteroids has the shortest duration of action?
Which of the following corticosteroids has the shortest duration of action?
Which route of administration is NOT commonly used for corticosteroid delivery?
Which route of administration is NOT commonly used for corticosteroid delivery?
What distinguishes long-acting corticosteroids from short-acting ones?
What distinguishes long-acting corticosteroids from short-acting ones?
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Which mineralocorticoid is mentioned and has an oral dose available?
Which mineralocorticoid is mentioned and has an oral dose available?
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What treatment is recommended for primary adrenal insufficiency?
What treatment is recommended for primary adrenal insufficiency?
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What defines secondary adrenal insufficiency in treatment considerations?
What defines secondary adrenal insufficiency in treatment considerations?
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How is acute adrenal insufficiency initially treated?
How is acute adrenal insufficiency initially treated?
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What is the purpose of in utero administration of dexamethasone?
What is the purpose of in utero administration of dexamethasone?
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What is the initial treatment for a patient who has undergone an adrenalectomy for Cushing’s syndrome?
What is the initial treatment for a patient who has undergone an adrenalectomy for Cushing’s syndrome?
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What is one major use of glucocorticoids (GCs) in the treatment of renal disease?
What is one major use of glucocorticoids (GCs) in the treatment of renal disease?
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Which allergic condition can be treated with glucocorticoids?
Which allergic condition can be treated with glucocorticoids?
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In the treatment of bronchial asthma, what is the role of inhaled glucocorticoids?
In the treatment of bronchial asthma, what is the role of inhaled glucocorticoids?
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What is a potential side effect of glucocorticoid withdrawal?
What is a potential side effect of glucocorticoid withdrawal?
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How can glucocorticoid toxicity be reduced after achieving a therapeutic response?
How can glucocorticoid toxicity be reduced after achieving a therapeutic response?
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Which ocular condition is treated using glucocorticoids?
Which ocular condition is treated using glucocorticoids?
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Which of the following is NOT a use of glucocorticoids?
Which of the following is NOT a use of glucocorticoids?
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What do glucocorticoids provide in response to allergic conditions?
What do glucocorticoids provide in response to allergic conditions?
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What is the major glucocorticoid produced in humans?
What is the major glucocorticoid produced in humans?
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Which condition is characterized by hypersecretion of adrenal hormones?
Which condition is characterized by hypersecretion of adrenal hormones?
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What is a primary action of glucocorticoids in the body?
What is a primary action of glucocorticoids in the body?
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What mechanism allows glucocorticoids to suppress inflammation?
What mechanism allows glucocorticoids to suppress inflammation?
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How do corticosteroids differ from mineralocorticoids?
How do corticosteroids differ from mineralocorticoids?
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What role does 11b-hydroxysteroid dehydrogenase type 2 play concerning cortisol?
What role does 11b-hydroxysteroid dehydrogenase type 2 play concerning cortisol?
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Which corticosteroid is commonly administered as an inhaled medication?
Which corticosteroid is commonly administered as an inhaled medication?
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What might be a consequence of long-term corticosteroid use?
What might be a consequence of long-term corticosteroid use?
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What is one of the benefits of Alternate Day Therapy in long-term therapy?
What is one of the benefits of Alternate Day Therapy in long-term therapy?
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Which condition is NOT a potential side effect of glucocorticoid therapy?
Which condition is NOT a potential side effect of glucocorticoid therapy?
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What is the main reason inhibitors of steroid synthesis are rarely used for treating Cushing’s syndrome?
What is the main reason inhibitors of steroid synthesis are rarely used for treating Cushing’s syndrome?
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Fludrocortisone is primarily used to treat what condition?
Fludrocortisone is primarily used to treat what condition?
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What is a primary action of spironolactone in the body?
What is a primary action of spironolactone in the body?
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What percentage of plasma cortisol is associated with Corticosteroid Binding Globulin (CBG)?
What percentage of plasma cortisol is associated with Corticosteroid Binding Globulin (CBG)?
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Which statement regarding glucocorticoids is inaccurate?
Which statement regarding glucocorticoids is inaccurate?
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What is a significant side effect associated with ketoconazole use?
What is a significant side effect associated with ketoconazole use?
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Study Notes
Learning Objectives
- Familiarize with commonly prescribed corticosteroids and their therapeutic uses.
- Understand mechanisms through which corticosteroids suppress inflammation and immune responses.
- Manage toxicities related to chronic corticosteroid use.
- Distinguish between mineralocorticoids and corticosteroids.
Key Drugs to Know
- Hydrocortisone (Cortisol): Short-acting corticosteroid.
- Prednisone/Prednisolone: Intermediate-acting corticosteroid.
- Dexamethasone and Betamethasone: Long-acting corticosteroids.
- Fludrocortisone: Mineralocorticoid used for adrenal insufficiency.
- Fluticasone: Inhaled corticosteroid for respiratory conditions.
Corticosteroids Overview
- Produced by adrenal cortex: glucocorticoids (e.g., cortisol) and mineralocorticoids (e.g., aldosterone).
- Cortisol mediates stress response and regulates metabolism (glucose, lipids, proteins).
- Adrenal disorders: Addison's Disease (hyposecretion) and Cushing's Syndrome (hypersecretion).
Mechanism of Action
- Glucocorticoids bind to glucocorticoid receptors (GR) and influence gene transcription by interacting with DNA elements.
- Can also bind mineralocorticoid receptors (MR) in certain tissues, often mitigated by the enzyme 11β-hydroxysteroid dehydrogenase type 2.
Routes of Administration
- Administered via multiple routes: IV, oral, nasal sprays, topical applications, ophthalmic forms, and IM injections.
Equivalence of Corticosteroids
- Short-acting: Hydrocortisone (anti-inflammatory effect = 1), equivalent oral dose = 20 mg.
- Intermediate-acting: Prednisone (anti-inflammatory effect = 4), equivalent oral dose = 5 mg.
- Long-acting: Dexamethasone (anti-inflammatory effect = 30), equivalent oral dose = 0.8 mg.
Replacement Therapy
- Treat adrenal insufficiencies with hydrocortisone and fludrocortisone.
- Acute adrenal insufficiency requires immediate IV hydrocortisone.
- In congenital adrenal hyperplasia, treatment may include in utero dexamethasone to prevent female virilization.
Therapeutic Applications
- Nonendocrine diseases treated with glucocorticoids:
- Allergic conditions, bronchial asthma, ocular diseases, inflammatory bowel diseases, cerebral edema, malignancies like leukemia and lymphomas.
Glucocorticoid Toxicity
- Two primary categories: Withdrawal toxicity and toxicity from prolonged supraphysiological doses.
- Common side effects include hyperglycemia, psychosis, osteoporosis, weight gain, and impaired wound healing.
Strategies to Reduce Toxicity
- Tapering Dose: Gradual reduction to prevent flares.
- Alternate Day Therapy: Minimizes side effects during long-term therapy.
- Localized Delivery: Focused treatment to reduce systemic exposure.
Inhibitors of Steroid Synthesis
- Drugs such as ketoconazole, metyrapone, and aminoglutethimide can inhibit steroidogenesis but have significant toxicity issues.
Mineralocorticoids
- Fludrocortisone used for adrenal insufficiency with mineralocorticoid deficiency, focused on retaining salt without anti-inflammatory effects.
Mineralocorticoid Antagonists
- Spironolactone: Treats hyperaldosteronism, restores potassium balance, and acts as a potassium-sparing diuretic.
- Eplerenone: Similar effects to spironolactone but lacking anti-androgenic properties.
Interesting Facts
- 90% of plasma cortisol is bound to corticosteroid-binding globulin (CBG); synthetic steroids predominantly bind to albumin.
- Glucocorticoids regulate approximately 10-20% of all genes.
- GR and MR have equal affinity for cortisol.
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Description
Test your knowledge on corticosteroids, their dosing, and routes of administration. This quiz covers the key aspects of anti-inflammatory use of prednisone, differences between long-acting and short-acting corticosteroids, and treatments for adrenal insufficiency. Perfect for students and professionals in pharmacology and medicine.
