steroids (NAPLEX)

Aldosterone replaced by giving ______

fludrocortisone

Fludocortisone indications (2)

• Addisons

• Orthostatic hypotension

T/F: cortisol can be replaced by giving any of the steroids

True

Glucocorticoid activity

Anti-inflammatory

Mineralcorticoid activity

Maintains water and electrolyte balance

HPA suppression

• When systemic steroids cause the adrenal gland to stop producing cortisol through feedback inhibition

• This is why we taper steroids to allow adrenal glands time to resume cortisol production

Add pic of pathway?

Adrenals product too much cortisol

A. Cushings syndrome

B. Addisons disease

A. Cushings syndrome

Adrenals don't make enough cortisol

A. Cushings syndrome

B. Addisons disease

B. Addisons disease

What would happen if you suddenly stop exogenous steroids?

Addisonian crisis or adrenal crisis which can be fatal

Features of cushing syndrome (7)

• Moon face

• Hirsutism

• HTN

• Muscle wasting

• Osteoporosis

• Central obesity

• Bruising

SYSTEMIC STEROID EQUIVALENCE (studygal)

• Cortisone 25 (lowest anti-inflamm)

• Hydrocortisone 20

• Prednisone 5

• Prednisolone 5

• Methylprednisolone 4

• Triamcinolone 4

• Dexamethasone 0.75

• Betamethasone 0.6 (highest anti-inflamm)

Cute Helpful Pharmacists and Physicians Marry Together & Delivery Babies

What steroid has the most anti-inflammatory properties?

Betamethasone

Glucosteriods adverse effects (short term vs long term)

SHORT TERM (<1 month)

• Fluid retention

• Stomach upset

• Emotional instability

• Insomnia

• Increased appetite

• Weight gain

• HTN

LONG TERM

• Increased cholesterol (TG & LDL)

• SXS of cushings

Prodrug of cortisol

Cortisone

Prodrug of prednisolone

Prednisone

Triamcinolone brand

Kenalog

Prednisolone Brand

Orapred ODT

Methylprednisolone brand (2)

Solu-Medrol, Medrol

Hydrocortisone brand

Solu-Cortef

A patient is considered immunosuppressed if ≥ __ mg/day of ______ **

≥20 mg/day, prednisone or prednisone equivalent