Steroids questions

Physiological functions of steroids?

• Increase blood glucose

  • Gluconeogenesis

  • counteracting with insulin

• Increase sodium and water retention

• Regulate (down) the immune response

Anti-inflammatory steroid type?

Glucocorticoids

Sodium and water retention, increase BP, steroid type?

Mineralcorticoid

What are the aldosterone like effects of mineralcorticoids?

• Increase serum sodium

• Increase water retention

• Increase BP

Mineralocorticoid indications?

Hypotension, severe, septic shock

Anti-inflammatory steroid effects?

• Inhibition of lymphocyte proliferations: T, B cells

• Inhibition of interleukin production

• Inhibition of capillary permeability to leukocytes

• Inhibition of prostaglandin production

Steroid order?

• Cortisone

• Hydrocortisone

• Prednisone

• Prednisolone

• Triamcinolone

• Methylprednisolone

• Betamethasone

• Dexamthasone

Steroid Indications?

Autoimmune diseases:

• Rheumatoid arthritis

• Sjogren’s disease

• Post-transplantation of solid organ

• anaphylactic reactions

• asthma

• allergic rhinitis

• traumatic injuries and inflammation

• shock and critically ill pts

Cardiovascular steroid ADRs?

Hypertension

• water and sodium retention

• inhibition of prostaglandin synthesis

• increase renal excretion of potassium

Why are infections an ADR of steroids?

due to impaired cell mediated immunity

GI steroid ADRs?

• GI perforations

• fistulas

• oropharyngeal and esophageal candidiasis

• PUD: peptic ulcer disease

Pt. risk factor of PUD?

Concurrent NSAID and steroid use

How can steroids induce osteoporosis?

• Decrease calcium GI absorption

• Increase calcium renal excretion

• Decrease androgen and estrogen production

• Inhibition of osteoblasts proliferation

• Stimulation of osteoclasts bone resorption activities

What supplements should pt. take if on steroids?

Calcium and vitamin D supplements

Ophthalmic steroid ADRs? Reversible?

• Glaucoma: reversible except for the optic nerve damage

• Cataract: irreversible, corrected by surgery

How do steroids cause glacoma?

• Increase intraocular pressure

• reduction of aqueous humor outflow

Glaucoma most/least incidence steroids?

Most: betamethasone, dexamethasone (anti-inflammatory)

Mod: prenisone

Lease: hydrocortisone

How can steroids cause acne?

• cutaneous and subcutaneous atrophy

• delayed wound healing

What syndrome can be caused by steroids?

cushing syndrome

Cushing syndrome caused by? Symptoms?

• caused by high doses of steroids over long period of time

• redistribution of body fat:

  • dorsocervical and supraclavicular

  • moon facing

  • central obesity

  • poor wound healing

  • easily bruising

  • hypertension