Podcast
Questions and Answers
Which of the following best describes the primary action of glucocorticoids that leads to steroid diabetes?
Which of the following best describes the primary action of glucocorticoids that leads to steroid diabetes?
- Enhancing the uptake of glucose by muscle cells.
- Directly stimulating insulin secretion from the pancreas.
- Promoting the breakdown of proteins and fats to increase gluconeogenesis. (correct)
- Inhibiting the release of glucagon from the liver.
A patient with chronic persistent asthma is using an inhaled corticosteroid as maintenance therapy. Which of the following indicates the asthma severity level, according to the National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines, that would warrant this treatment?
A patient with chronic persistent asthma is using an inhaled corticosteroid as maintenance therapy. Which of the following indicates the asthma severity level, according to the National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines, that would warrant this treatment?
- Step 1 asthma, characterized by intermittent symptoms less than 2 days a week.
- Step 2 asthma or greater, indicating symptoms more than 2 days a week but not daily. (correct)
- Step 4 asthma only, necessitating high-dose inhaled corticosteroids and long-acting beta-agonists.
- Step 3 asthma only, requiring daily medication due to persistent symptoms.
A patient's asthma symptoms are well-controlled with inhaled corticosteroids, but they are still experiencing occasional night awakenings (3-4 nights per month). According to the National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines, which lung function measurement would be expected in this scenario?
A patient's asthma symptoms are well-controlled with inhaled corticosteroids, but they are still experiencing occasional night awakenings (3-4 nights per month). According to the National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines, which lung function measurement would be expected in this scenario?
- FEV1 or PEF less than 60% of predicted.
- FEV1 or PEF 80% of predicted or greater. (correct)
- FEV1 or PEF between 60% and 79% of predicted.
- FEV1 or PEF varying widely throughout the day, with no consistent pattern.
In the context of asthma management, when might systemic corticosteroids be considered alongside inhaled corticosteroids, and for what primary purpose?
In the context of asthma management, when might systemic corticosteroids be considered alongside inhaled corticosteroids, and for what primary purpose?
What differentiates an 'exogenous' substance from an 'endogenous' one in the context of respiratory pharmacology?
What differentiates an 'exogenous' substance from an 'endogenous' one in the context of respiratory pharmacology?
Which of the following best describes the mechanism by which inhaled corticosteroids can lead to HPA axis suppression?
Which of the following best describes the mechanism by which inhaled corticosteroids can lead to HPA axis suppression?
A patient on long-term inhaled corticosteroid therapy is experiencing symptoms of adrenal suppression. Which strategy would be LEAST appropriate for managing this complication?
A patient on long-term inhaled corticosteroid therapy is experiencing symptoms of adrenal suppression. Which strategy would be LEAST appropriate for managing this complication?
Why are inhaled corticosteroids often preferred over systemic corticosteroids for long-term management of asthma?
Why are inhaled corticosteroids often preferred over systemic corticosteroids for long-term management of asthma?
A patient with asthma is prescribed fluticasone propionate/salmeterol (Advair). What is the primary rationale for using this combination therapy?
A patient with asthma is prescribed fluticasone propionate/salmeterol (Advair). What is the primary rationale for using this combination therapy?
Which of the following physiological responses occurs during the 'flare' phase of the triple response to inflammation?
Which of the following physiological responses occurs during the 'flare' phase of the triple response to inflammation?
In the context of the inflammatory response in asthma, what is the role of mast cells?
In the context of the inflammatory response in asthma, what is the role of mast cells?
A patient's asthma symptoms are well-controlled with inhaled corticosteroids, but they report experiencing hoarseness. What would you recommend?
A patient's asthma symptoms are well-controlled with inhaled corticosteroids, but they report experiencing hoarseness. What would you recommend?
A researcher is investigating the effects of a novel anti-inflammatory drug on the late-phase asthmatic response. Which cellular process should they focus on to assess the drug's efficacy?
A researcher is investigating the effects of a novel anti-inflammatory drug on the late-phase asthmatic response. Which cellular process should they focus on to assess the drug's efficacy?
Which inhaled corticosteroid is available in a dry powder inhaler (DPI) formulation?
Which inhaled corticosteroid is available in a dry powder inhaler (DPI) formulation?
A patient reports that they are consistently waking up at 3:00 AM with asthma symptoms. Understanding the diurnal variation of cortisol levels, what might be contributing to this?
A patient reports that they are consistently waking up at 3:00 AM with asthma symptoms. Understanding the diurnal variation of cortisol levels, what might be contributing to this?
Flashcards
Adrenal Cortical Hormones
Adrenal Cortical Hormones
Chemicals (steroids) secreted by the adrenal cortex.
Endogenous
Endogenous
Produced inside the body.
Exogenous
Exogenous
Manufactured to be placed inside the body.
Steroids
Steroids
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Inhaled Corticosteroids Use
Inhaled Corticosteroids Use
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Aerosolized Corticosteroids
Aerosolized Corticosteroids
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HPA Axis
HPA Axis
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HPA Suppression
HPA Suppression
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Circadian Steroid Cycle
Circadian Steroid Cycle
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Alternate-Day Steroid Therapy
Alternate-Day Steroid Therapy
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Corticosteroids
Corticosteroids
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Inflammation Signs
Inflammation Signs
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Four Categories of Inflammatory Response
Four Categories of Inflammatory Response
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Anti-inflammatory Goal in Airway Disease
Anti-inflammatory Goal in Airway Disease
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Biphasic Asthmatic Reaction
Biphasic Asthmatic Reaction
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Study Notes
- Adrenal cortical hormones are steroids secreted by the adrenal cortex.
- Endogenous refers to substances produced inside the body.
- Exogenous refers to substances manufactured to be placed inside the body, like medication.
- Immunoglobulin E (IgE) is a gamma globulin produced by respiratory tract cells.
- Prostaglandins are hormone-type substances circulating throughout the body.
- Steroid diabetes involves hyperglycemia resulting from glucocorticoid therapy
- Glucocorticoids break down proteins and fats to generate building blocks for gluconeogenesis
Clinical Indications for Inhaled Corticosteroids
- Inhaled corticosteroids are available for oral inhalation (lung delivery) and intranasal delivery.
- Orally inhaled agents are for maintenance and control therapy of chronic persistent asthma requiring step 2 care or greater.
- Step 2 asthma includes symptoms occurring more than 2 days/week but not daily, night awakenings 3-4 nights/month, with FEV1 or PEF ≥ 80% predicted.
- Inhaled agents can be used with systemic corticosteroids in severe asthma, potentially reducing or eliminating the need for systemic steroids.
- The American Thoracic Society (ATS) recommends inhaled corticosteroids in combination with other agents.
Identification of Aerosolized Corticosteroids:
- Beclomethasone dipropionate HFA (QVAR)
- Flunisolide hemihydrate HFA (AeroSpan)
- Fluticasone propionate (Flovent HFA, Flovent Diskus)
- Fluticasone furoate (Arnuity Ellipta)
Identification of Aerosolized Corticosteroid Combinations:
- Fluticasone propionate/salmeterol (Advair Diskus, Advair HFA)
- Budesonide/formoterol fumarate HFA (Symbicort)
- Mometasone furoate/formoterol fumarate HFA (Dulera)
- Fluticasone furoate/vilanterol (Breo Ellipta)
Hypothalamic-Pituitary-Adrenal Axis (HPA Axis)
- Pathway for release and control of endogenous corticosteroids:
- Hypothalamus stimulation leads to corticotropin-releasing factor (CRF) release.
- CRF goes to the anterior pituitary gland, releasing corticotropin into the bloodstream.
- Corticotropin, or adrenocorticotropic hormone (ACTH), stimulates the adrenal cortex to secrete glucocorticoids like cortisol.
HPA Suppression with Steroid Use
- The body can't differentiate between endogenous and exogenous sources.
- Glucocorticoid drugs increase the body's glucocorticoid level.
- This inhibits the hypothalamus and pituitary glands.
- This is known as HPA suppression or adrenal suppression.
Physiology of Aerosolized Corticosteroids
- The body's glucocorticoid production follows a diurnal or circadian rhythm.
- Cortisol levels are highest in the morning around 8 a.m.
- Interference with the cycle can be caused by jet lag or night shift work.
Alternate-Day Steroid Therapy
- This mimics the natural diurnal rhythm.
- A steroid drug is given early in the morning when natural tissue levels are high.
- On alternate days, the regular diurnal secretion in the HPA system can resume.
- Corticosteroids are used with asthmatics and COPD patients to achieve an anti-inflammatory effect.
Nature of Inflammatory Response
- Inflammation produces redness, swelling, heat, and pain.
- Triple response includes:
- Redness: Local dilation of blood vessels occurring in seconds.
- Flare: Reddish color spreading several centimeters from the site 15-30 seconds after injury.
- Wheal: Local swelling occurring in minutes.
Four Categories of Inflammatory Response:
- Increased vascular permeability: An exudate forms in surrounding tissues.
- Leukocytic infiltration: White blood cells (WBC) emigrate through capillary walls (diapedesis) due to chemotaxis.
- Phagocytosis: White cells and macrophages ingest and process foreign material.
- Mediator cascade: Histamine and chemoattractant factors are released, generating inflammatory mediators.
Inflammation of Airway
- Chronic bronchitis (usually from smoking) and asthma are most common.
- Treatment with anti-inflammatory agents, like glucocorticoids, reduces basal airway inflammation.
- This reduces airway hyperresponsiveness.
Asthmatic Reactions:
- Asthmatic reactions are biphasic, with early and late phases.
- The early asthmatic response is caused by immunoglobulin E (IgE).
- The early response peaks at about 15 minutes.
- Mast cells and eosinophils are major cells responsible for the inflammatory response in asthma.
- Mast cell mediators and cytokines recruit other inflammatory cells, causing the late-phase reaction.
- The late-phase response occurs after approximately 6–8 hours and can last up to 24 hours.
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Description
Inhaled corticosteroids are used for maintenance and control of chronic persistent asthma. They are available for oral inhalation and intranasal delivery. These steroids help manage asthma symptoms occurring more than twice a week, including night awakenings.
