Podcast
Questions and Answers
Which of the following best describes the action of glucocorticoids that leads to steroid diabetes?
Which of the following best describes the action of glucocorticoids that leads to steroid diabetes?
- They inhibit the breakdown of glycogen in the liver, leading to increased storage of glucose and subsequent hyperglycemia.
- They directly stimulate insulin secretion from the pancreas, leading to hyperglycemia.
- They enhance glucose uptake by cells, causing an initial spike in blood sugar followed by a hypoglycemic episode.
- They break down proteins and fats, providing building blocks for gluconeogenesis, which elevates plasma glucose levels. (correct)
A patient with chronic persistent asthma is prescribed inhaled corticosteroids. According to the National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines, at which step of asthma care is this medication indicated?
A patient with chronic persistent asthma is prescribed inhaled corticosteroids. According to the National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines, at which step of asthma care is this medication indicated?
- Step 1, for intermittent asthma with infrequent symptoms.
- Step 2 or greater, for persistent asthma requiring daily controller medication. (correct)
- As a rescue medication for acute asthma exacerbations at any step.
- Only in severe, uncontrolled asthma at Step 4 or 5.
In the context of medication, what is the difference between an 'endogenous' substance and an 'exogenous' substance?
In the context of medication, what is the difference between an 'endogenous' substance and an 'exogenous' substance?
- Endogenous substances are fast-acting, while exogenous substances are slow-acting.
- Endogenous substances are produced inside the body, while exogenous substances are manufactured to be introduced into the body. (correct)
- Endogenous substances are only produced in response to external stimuli, while exogenous substances are always present.
- Endogenous substances are synthetic, while exogenous substances are naturally occurring.
A patient with severe asthma is currently taking systemic corticosteroids. What is the potential benefit of adding inhaled corticosteroids to their treatment regimen?
A patient with severe asthma is currently taking systemic corticosteroids. What is the potential benefit of adding inhaled corticosteroids to their treatment regimen?
A patient experiences asthma symptoms more than twice a week but not daily, and night awakenings occur 3-4 nights per month. Their FEV1 is 85% of the predicted value. According to asthma guidelines, which step of care does this patient fall into?
A patient experiences asthma symptoms more than twice a week but not daily, and night awakenings occur 3-4 nights per month. Their FEV1 is 85% of the predicted value. According to asthma guidelines, which step of care does this patient fall into?
Which of the following best explains how the administration of exogenous glucocorticoids leads to HPA axis suppression?
Which of the following best explains how the administration of exogenous glucocorticoids leads to HPA axis suppression?
A patient reports working night shifts and is experiencing disrupted sleep patterns. How might this affect their natural steroid cycle?
A patient reports working night shifts and is experiencing disrupted sleep patterns. How might this affect their natural steroid cycle?
Why is it important to use anti-inflammatory agents such as glucocorticoids in patients with chronic bronchitis and asthma?
Why is it important to use anti-inflammatory agents such as glucocorticoids in patients with chronic bronchitis and asthma?
Which of the following is the primary mechanism by which inhaled corticosteroids reduce airway inflammation in asthma?
Which of the following is the primary mechanism by which inhaled corticosteroids reduce airway inflammation in asthma?
A patient with asthma experiences an early-phase asthmatic response. What is the primary immunological event driving this response?
A patient with asthma experiences an early-phase asthmatic response. What is the primary immunological event driving this response?
After an injury, a patient experiences redness, followed by a flare, and then a wheal. What is the correct sequence and timing of these events in the inflammatory response?
After an injury, a patient experiences redness, followed by a flare, and then a wheal. What is the correct sequence and timing of these events in the inflammatory response?
Which of the following is NOT a component of the inflammatory response?
Which of the following is NOT a component of the inflammatory response?
A physician prescribes alternate-day steroid therapy. What is the physiological rationale behind this approach?
A physician prescribes alternate-day steroid therapy. What is the physiological rationale behind this approach?
In the context of the inflammatory response, what role does chemotaxis play?
In the context of the inflammatory response, what role does chemotaxis play?
A patient is prescribed Fluticasone propionate/salmeterol (Advair). What is the purpose of combining these two medications?
A patient is prescribed Fluticasone propionate/salmeterol (Advair). What is the purpose of combining these two medications?
Flashcards
Adrenal Cortical Hormones
Adrenal Cortical Hormones
Chemicals, referred to as steroids, secreted by the adrenal cortex.
Endogenous
Endogenous
Produced inside the body.
Exogenous
Exogenous
Manufactured outside the body to be placed inside (e.g., medication).
Immunoglobulin E (IgE)
Immunoglobulin E (IgE)
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Steroids
Steroids
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Aerosolized Corticosteroids
Aerosolized Corticosteroids
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Hypothalamic-Pituitary-Adrenal Axis (HPA Axis)
Hypothalamic-Pituitary-Adrenal Axis (HPA Axis)
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HPA Suppression
HPA Suppression
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Diurnal/Circadian Steroid Cycle
Diurnal/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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Triple Response
Triple Response
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Four Categories of Inflammatory Response
Four Categories of Inflammatory Response
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Early Asthmatic Response
Early Asthmatic Response
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Late Asthmatic Response
Late Asthmatic Response
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Study Notes
- Adrenal cortical hormones are chemicals, known as steroids, secreted by the adrenal cortex.
- Endogenous refers to substances produced inside the body.
- Exogenous refers to substances manufactured outside the body to be placed inside.
- Immunoglobulin E (IgE) is a gamma globulin produced by respiratory tract cells.
- Prostaglandins are hormone-type substances circulating throughout the body.
- Steroid diabetes refers to hyperglycemia resulting from glucocorticoid therapy.
- Steroids, also known as glucocorticoids or corticosteroids, are anti-inflammatory agents.
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.
- Step 2 asthma includes symptoms occurring more than 2 days/week, but not daily; 3-4 night awakenings/month; and FEV1 or PEF 80% predicted or greater.
- Inhaled agents can be used with systemic corticosteroids in severe asthma.
- They may allow for reduction or elimination of systemic corticosteroids for asthma control.
- Inhaled corticosteroids in combination with other agents are recommended by the American Thoracic Society (ATS).
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 Corticosteroids (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)
- It's the pathway for the release and control of endogenous corticosteroids.
- Hypothalamus stimulation causes impulses to be sent to the median eminence, for corticotropin-releasing factor (CRF) release.
- CRF goes to anterior pituitary gland, where corticotropin is released into bloodstream.
- Corticotropin, or adrenocorticotropic hormone (ACTH), stimulates the adrenal cortex to secrete glucocorticoids, like cortisol.
HPA Suppression with Steroid Use
- The body cannot distinguish between endogenous and exogenous steroids.
- Administration of glucocorticoid drugs raises the body’s level.
- This inhibits the hypothalamus and pituitary glands, which leads to HPA or adrenal suppression.
Physiology of Aerosolized Corticosteroids
- The production of the body’s own glucocorticoids follows a rhythmic cycle, termed diurnal or circadian rhythm.
- Cortisol levels are highest in the morning at 8 a.m.
- Interference with the cycle may result from jet lag or night shift work.
Alternate-Day Steroid Therapy
- It mimics the natural diurnal rhythm.
- Steroid drug is administered early in the morning when normal tissue levels are high.
- On alternate days, regular diurnal secretion in the HPA system can resume.
Corticosteroids
- They are a class of medications used to treat inflammation.
- 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.
- The triple response includes:
- Redness: Local dilation of blood vessels, occurring in seconds
- Flare: Reddish color several centimeters from the site, occurring 15 to 30 seconds after injury
- Wheal: Local swelling, occurring in minutes
Four Categories of the Nature of Inflammatory Response
- Increased vascular permeability causes an exudate to form in surrounding tissues.
- Leukocytic infiltration is when white blood cells (WBC) emigrate through capillary walls (diapedesis) in response to attractant chemicals (chemotaxis).
- Phagocytosis is when white cells and macrophages (in lungs) ingest and process foreign material such as bacteria.
- The mediator cascade is when histamine and chemoattractant factors are released at the injury site, and various inflammatory mediators, such as complement and arachidonic acid products, are generated.
Inflammation of the Airway
- Chronic bronchitis (usually from tobacco smoking) and asthma (range of triggers) are most common.
- Treatment with anti-inflammatory agents like glucocorticoids is important to reduce basal level of airway inflammation.
- This reduces airway hyperresponsiveness and predisposition to acute episodes of obstruction.
- Asthmatic reactions are biphasic, including an early and late phase.
- The early asthmatic response is caused by immunoglobulin E (IgE).
- The early response peaks at approximately 15 minutes.
- Mast cells and eosinophils are the major cells responsible for an inflammatory response in asthma.
- Mast cell mediators and release of cytokines recruit other inflammatory cells to cause a late-phase reaction.
- The late response occurs after approximately 6–8 hours and can last up to 24 hours.
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Description
Overview of adrenal cortical hormones and steroids, including endogenous and exogenous substances. Focus on inhaled corticosteroids for asthma maintenance and control, particularly in Step 2 asthma. Discusses clinical uses and considerations.
