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Questions and Answers
What is the oral dose of prednisone for anti-inflammatory use initially?
Which of the following corticosteroids has the shortest duration of action?
Which route of administration is NOT commonly used for corticosteroid delivery?
What distinguishes long-acting corticosteroids from short-acting ones?
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Which mineralocorticoid is mentioned and has an oral dose available?
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What treatment is recommended for primary adrenal insufficiency?
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What defines secondary adrenal insufficiency in treatment considerations?
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How is acute adrenal insufficiency initially treated?
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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?
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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?
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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?
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How can glucocorticoid toxicity be reduced after achieving a therapeutic response?
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Which ocular condition is treated using glucocorticoids?
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Which of the following is NOT a use of glucocorticoids?
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What do glucocorticoids provide in response to allergic conditions?
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What is the major glucocorticoid produced in humans?
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Which condition is characterized by hypersecretion of adrenal hormones?
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What is a primary action of glucocorticoids in the body?
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What mechanism allows glucocorticoids to suppress inflammation?
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How do corticosteroids differ from mineralocorticoids?
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What role does 11b-hydroxysteroid dehydrogenase type 2 play concerning cortisol?
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Which corticosteroid is commonly administered as an inhaled medication?
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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?
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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?
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Fludrocortisone is primarily used to treat what condition?
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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)?
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Which statement regarding glucocorticoids is inaccurate?
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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.
