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Intro to Pharm
Pain & Inflammation/NSAIDS, DMAARDS, Steroids, gout
| Question | Answer |
|---|---|
| What are the five signs of inflammation? | SHARP: swelling, heat, altered function, redness, pain |
| What are the physiological signs of inflammation? | vasodilation, increased permeability of blood vessels, recruitment of neutrophils & macrophages |
| Can enzymes digest normal tissues? | Yes, enzymes can. |
| Can swelling lead to death? | Yes, if it obstructs airways or the cranial cavity. |
| What is the Triple Response of Lewis? | 1.Immediate red scratch mark 2. Red flare around scratch mark 3.Red, swollen area around flare |
| What are some mediators of acute inflammation? | histamine, serotonin, bradykinin, prostaglandins, leukotrienes |
| What are prostaglandins derived from? | Derived from arachidonic acid from the diet & then stored until needed. |
| What aspects of disease do prostaglandins play a role in? | Inflammation (swelling, permeability), pain (increase sensitivity of receptors), fever, dysmenorrhea, thrombus formation, asthma/diabetes/cardiovascular disorders |
| What impact do anti-inflammatory drugs have on prostaglandins? | They prevent the synthesis of prostaglandins |
| What are three useful effects of anti-inflammatory medication? | suppression of inflammation, relief of pain, reduction of fever |
| What are three adverse effects of anti-inflammatory medication? | gastric ulceration, suppression of platelet aggregation, induction of acute renal failure |
| What are three therapeutic agents for treating pain and inflammation? | NSAIDS (nonsteroidal anti-inflammatory drugs), glucocorticoids (steroids), DMARDS (disease-modifying antirheumatic drugs) |
| What is the mechanism of action for NSAIDS (nonsteroidal anti-inflammatory drugs)? | To block cyclooxygenase or COX. |
| What is produced by COX (cyclooxygenase)? | prostaglandins are produced |
| What is produced by LOX (lipoxygenase)? | leukotrienes are produced |
| What are some characteristics of COX-1? | housekeeping, always turned on, platelet/kidney/stomach |
| What are some characteristics of COX-2? | Inflammation process, rapidly induced (must be turned on by inflammation process), no effects on stomach |
| What are eight protoypes of NSAIDS? | 1. asprin2. ibuprofen (advil/motrin/nuprin), naproxen (aleve/naprosyn)3. ketoroloc (torodol)4. piroxicam (feldene)5. indomethacin (indocin)6. celecoxib (celebrex)7. rofecoxib (vioxx)8. acetaminophen (tylenol)-->analgesic |
| What are four actions of asprin? | analgesic (low intensity), anti-pyretic, anti-inflammatory (very large doses), antiplatelet (interferes with clotting) |
| What are some therapeutic uses of asprin? | suppression of inflammation/arthritis, analgesia (mild to moderate), reduces fever, dysmenorrhea, suppression of platelet aggregation |
| What are some side effects of asprin? | mechanism of action: IRREVERSIBLY inhibits COX; GI: blocks protective prostaglandins; blood: increases bleeding; Uterus: decreases contractions; kidney: promotes retention; respiration: stimulates |
| What are the symptoms of asprin toxicity? | GI ulcers, hypersensitivity (could lead to lung constriction), overdose (could be fatal), pregnant females should not take (could prolong labor), Reye's Syndrome (seen in children, potentially fatal), alcohol (decreased clotting ability) |
| What are some drug interactions to be aware of with asprin? | Warfarin (anti-coagulant), glucocorticoids (promotes ulcers), alcohol (increase risk of gastric bleeding), ibuprofen (decrease antiplatelet effect) |
| What are some implications of asprin poisoning (approximately >20-25mg adult, 4g child)? | death from respiratory failure, treat with ventilator |
| What are some contraindications for asprin use? | kidney problems, preexisting bleeding disorder, history of peptic ulcer/asthma, use combined with anticoagulants/glucocorticoids/alcohol, pregnancy (may cause anemia/hemorrhage |
| Name three salicylates. | asprin, magnesium salicylate (doan's), topical salicylate (ben-gay) |
| What is the mechanism of action for ibuprofen/naproxen? | inhibits COX |
| Which has a shorter duration of action, ibuprofen or naproxen? | ibuprofen has a shorter duration of action, so you would need to take it more often to have the same effects |
| What are three actions of ibuprofen/naproxen? | anti-inflammatory, anti-pyretic, analgesic (NO PLATELET EFFECTS LIKE ASPRIN) |
| What are some therapeutic uses of ibuprofen/naproxen? | suppression of inflammation, rheumatoid arthritis, moderate pain, fever, dysmenorrhea (best drug for this), naproxen only: bursitis/tendonitis, better tolerated NSAIDS, ibuprofen: safe to use with anticoagulants |
| What is the mechanism of action for Ketoroloc (Toradol)? | inhibits COX |
| What are some characteristics of Ketoroloc (Toradol)? | alternative for opioid analgesics, only injectable NSAID, LESS anti-inflammatory activity |
| What are the mechanisms of action for Piroxicam (Feldane)? | inhibits COX, high concentrations may decrease free radical production, half life is 50-60 hours, so 1x/day dose |
| What are some characteristics of Piroxicam (Feldane)? | antiplatelet like asprin, used to treat Rheumatoid arthritis/osteoarthritis, 9.5x higher risk for peptic ulcer & bleeding |
| What is the mechanism of action for Indomethacin (Indocin)? | inhibits COX |
| What are some characteristics of Indomethacin (Indocin)? | anti-platelets like asprin, arthritis/bursitis/tendonitis/ductus areteriosus closure (premies), may result in headache or seizure |
| What are some other NSAIDS & two characteristics of them? | oxaprozin (daypro), etodolac (lodine), Nabumetone (dolobid), mefenamic acid, nabumentone, all result in GI side effects, same drug interactions |
| What is the mechanism of action for Celecoxib (Celebrex)? | selective COX-2 inhibition (leaves protective prostaglandins in stomach) |
| What are some characteristics of Celecoxib (celebrex)? | used for OA/RA, three actions: anti-inflammatory/ anti-pyretic/ analgesic, NO PLATELET AGGREGATION, causes fewer GI ulcers than other NSAIDs |
| What are some side effects of celecoxib (celebrex)? | renal impairment, sulfa allergy, not to be used for 3rd trimester of pregnancy, not to be used in conjunction with anti-coagulants |
| What is the mechanism of action for Rofecoxib (vioxx)? | selective COX-2 inhibition |
| What are some characteristics of Rofecoxib (vioxx)? | recent removal from market due to increased risk of MI at high doses, was used for OA/RA/acute pain/dysmenorrhea, NO PLATELET AGGREGATION, fewer GI ulcers than other NSAIDs |
| What is the mechanism of action for acetaminophen? | WEAK inhibition of COX, only able to inhibit prostaglandins in the CNS (other NSAIDs inhibit in CNS & periphery) |
| What are the two actions for acetaminophen? | analgesic, anti-pyretic (NOT anti-inflammatory agent) |
| What action is acetaminophen categorized under? | analgesic |
| What is a possible side effect of acetaminophen? | liver toxicity because it depletes glutathione groups which are needed to react with intermediate produced |
| What are some characteristics of acetaminophen? | does not cause GI bleeding, rarely causes hypersensitivity |
| What are some characteristics of rheumatoid arthritis & gout? | autoimmune inflammatory disease (inflammation of membrane envelopes cartilage & enzymes destroy cartilage), joint stiffness, nondrug measures include PT/surgery/exercise, drug therapies include NSAIDS, DMARDS |
| What is the range of time drug effects of DMARDS (disease-modifying antirheumatic drugs) take to be evident? | 6 weeks to 6 months |
| What are some prototypes of DMARDS (disease-modifying antirheumatic drugs)? | Methrotrexate (rheumatrex), Cyclophosphamide, Chloroquine, Sulfasalazine (azulfidine), Gold (myocrisin), Leflunomide (arava), Entanercept (enbrel) |
| What are some characteristics of Methrotrexate (rheumatrex)? | rapid acting for DMARD (3-6 weeks to work), possible mechanism for action: inhibit cytokines), administered once per week |
| What are some possible side effects of Methrotrexate (rheumatrex)? | liver fibrosis, bone marrow suppression (contraindicated for pregnancy) |
| What are some characteristics of Sulfasalazine (azulfidine)? | treats inflammatory bowel disease, retards progression of joint deterioration |
| What are some possible side effects of Sulfasalazine (azulfidine)? | GI irritation & rash |
| What are some characteristics of Gold (myocrisin)? | high rate of d/c due to toxicity (dermatitis), exact mechanism is unknown: may alter macrophage function/morphology & decrease histamine |
| What are some characteristics of Leflunomide(arava)? | slow formation of bone erosion, well tolerated/benefits in one month |
| What is the mechanism of action for Leflunomide (arava)? | stop lymphocyte activation |
| What are some side effects of Leflunomide (arava)? | GI distress, rash, liver function |
| What are the most potent & effective drugs against CHRONIC inflammatory diseases? | steroids |
| What are the first line of treatment for asthma? | inhaled steroids |
| What is the type of steroid used for arthritis? | prednisone |
| What is the mechanism of action for steroids? | binds to a receptor, activates complex, localizes to nucleus, induction or repression of target genes |
| What are the two reasons steroids are effective? | inhibit cytokines which can also act as mediators of inflammation, increase synthesis of annexin I which inhibits phospholipase A2 (no a. acid = no prostaglandin synthesis |
| What are some problems seen with chronic steroid use? | fractures, infections, cateracts, diabetes, hypertension |
| What are some characteristics of osteoarthritis (OA)? | intrinsic defect in the joint cartilage/not immune response, more prevalent than rheumatoid arthritis |
| What percent of individuals >65 years old have been diagnosed with OA? >75 years? | 50-80%; 100% |
| What is the goal of drug therapy for individuals with OA? | it intends to manage pain & encourage active lifestyle (NOT treat joint inflammation) (acetaminophen/NSAIDs-symptomatic) |
| What is the goal of viscosupplements for individuals with OA? | restore lubrication properties of fluid in joints by injection of hyaluronan (benefits: 6months to one year |
| What are the possible effects of Glucosamine & Chondroitin Sulfate for individuals with OA? | decrease pain & improve function |
| What are some concerns in rehab related to arthritis? | glucocorticoids: effects on muscle/tendon/bone/skin; ROM/strength programs: be careful of fractures & soft tissue injuries; preven skin breakdown (splints, etc) |
| What causes gout? | deposits of urate in the joints & cartilage (causing recurrent episodes of acute arthritis) |
| How do urate depositions impact the inflammatory process in individuals with gout? | the phagocytosis of urate crystals leads to the secretion of inflammatory mediators (including prostaglandins, etc); leukocytes migrate into the joint space to amplify inflammation |
| What does treatment of gout include? | suppress different phases of leukocyte activation (Cholchicine), inhibit urate crystal phagocytosis (Indomethacin), Decrease the pool of urate available (Probenacid) |
| What are some characteristics of Cholchicine? | prophylaxis of recurrent episodes of gouty arthritis, binds to tubulin (preventing polymerization into microtubules, so inhibits leukocyte migration & phagocytosis), troublesome diarrhea |
| What is the role of NSAIDs in the treatment of gout? | inhibit prostaglandin synthesis & inhibit urate phagocytosis; initial treatment of gout is indomethacin (acute gout) |
| What is the role of uricosuric agents in the treatment of gout? | Probenacid: decreases the net reabsorption of uric acid by affecting the transporter sites; need large volume of urine to minimize risk of kidney stones |
| What are opioids? | agents which relieve pain INDEPENDENTLY of any anti-inflammatory effect (acetaminophen is considered an analgesic) |
| What are narcotics? | include any drug that dulls a person's perception of pain & induces sleep |
| What are three endogenous opioids? | enkephalins, endorphins, dynorphins |
| What impact do opioid agonists have on neurotransmitters? | they result in a decrease in release of neurotransmitters |
| What are three receptors for opioids? | Mu, kappa, delta |
| Opioids act on G-protein coupled receptors, therefore, they affect what? | ion gating, intracellular calcium, protein phosphorylation |
| What is the receptor distribution? | receptors are present on the spinal cord & primary afferents that relay pain message to spinal cord; drugs are given directly to spinal cord |
| What are 8 effects of opioid agonists? | analgesia, euphoria, sedation, CONSTIPATION, COUGH SUPPRESSION, RESPIRATORY DEPRESSION, nausea (stimulates chemoreceptor zone), PUPIL CONSTRICTION |
| What are some therapeutic uses of opioids? | analgesia, acute pulmonary edema, cough, diarrhea, anesthesia, rectal suppositories, except for codeine/oxycodone/tramadol: all are effective for alleviating moderate & severe pain; all produce tolerance & physical dependence through Mu receptor activatio |
| What are nine opioid agonists? | Morphine, Heroin, Codeine, Oxycodone (OxyContin/Percocet), Methodone (Dolophine), Meperidine (Demerol), Fentanyl (Sublimaze), Tramadol (Ultraam), Dextromethorphan (Benylin DM/Delsym) |
| What are some characteristics of morphine? | principle alkaloid in opium, Mu agonist, does not reach brain quickly, lasts 4-5 hours |
| What are some effects of morphine? | relieves pain, mental clouding, orthostatic hypertension, constipation, pupil constriction, respiratory depression, urinary retention, emesis, elevation of intracranial pressure, tolerance/physical dependence, drug interactions with alcohol/barbituates/an |
| What are some characteristics of heroin? | gets into the brain more rapidly than morphine, no evidence of greater effectivenss than morphine, high abuse potential |
| What are some characteristics of codeine? | mild to moderate pain, side effects limit the maximum tolerated, often used in combination with asprin or acetaminophen |
| What are some characteristics of oxycodone (ocycontin, percocet)? | never achieve morphine-like efficacy, Schedule II drug (very addictive) |
| What are some characteristics of Methadone (Dolophine)? | Mu agonist, longer duration of action, useful in treatment of opioid abuse because milder withdrawl symptoms so can taper off |
| What are some characteristics of Meperidine (Demerol)? | shorter duration of action than morphine, forms a toxic metabolite that can accumulate |
| What are some characteristics of Fentanyl (Sublimaze)? | Mu agonist, 100x more potent than morphine, short acting (1-1.5 hours), synthetic heroin-health professionals abuse |
| What are some characteristics of Tramadol (Ultraam)? | weak Mu agonist, mild to moderate pain, may cause seizures, useful in chronic neuropathic pain |
| What are some characteristics of Dextromehorphan (Benylin, DM, Delsym)? | Mu agonist, antitussive, not analgesic or addictive, produces less constipation than codeine |
| What are the two drugs used for cough suppression? | Codeine or dextromethorphan |
| What are two opioid antagonists? | Naloxone (Narcon), Naltrexone (ReVia, Depade) |
| What is Naloxone (Narcon)? | mu antagonist used to treat opioid overdoses |
| What is Naltrexone (ReVia, Depade)? | used to treat alcoholism, blocks endogenous opioids that give feeling of euphoria |
| What are two characteristics of opioid agonist-antagonists? | agonist at kappa; antagonist at mu, less powerful drugs but less addictive |
| What is one opioid agonist-antagonist & some characteristics? | Nalbuphine (Nubain): moderate pain, less side effects than agonist, produce more psychotropic effects |
| What are some characteristics regarding opioid tolerance? | rapid for nausea & vomiting; moderate for euphoria & analgesic effects; little or none for constipation & pupil constriction |
| How long does opioid physical dependence take to occur? | when drug administration stops: body functions abnormally, occurs as early as 6 hours after withdrawl |
| What are some symptoms of physical dependence? | restlessness, sweating, yawning, irritability, anorexia, tremor, depression, weakness, vomiting, increased heart rate, dehydration, etc |
| What are some characteristics of opioid abuse? | craving, drug seeking behavior, withdrawl (in order to rid tolerance & increase ability to get high on less drugs), treat with drugs or behavioral therapy |
| What are some aspects of patient-controlled analgesics? | self-administer small amount of medication on frequent basis; provides better pain control with smaller quantities; provided through a pump |
| Why should one avoid combinations of opioid drugs? | depressant effects of one drug will add to another |
| What are some impairments seen in athletes who abuse opioids? | impairment of hand-eye coordination & the failure to recognize serious injuries because of decreased pain threshold |
| What aspects of regulating normal physiological function are histamine involved in? | one mediator in allergic reactions, one mediator in the tissue response to injury, mediator of gastric acid secretion, may serve in CNS neural modulation |
| What can inhibit histamine release? | Cromolyn Sodium, epinephrine (drug of choice for anaphylactic shock), terbutaline (acute asthma attacks), Theophylline (2nd line therapy), Corticosteroids (most often used for asthma treatment) |
| What does Cromolyn Sodium (Nasalcrom) do to inhibit histamine release? | stabilizes mast cells & prevents release of contents |
| What are some characteristics/side effects of Cromolyn Sodium (Nasalcrom)? | takes 2-3 weeks to be effective, side effects: burning, itching, sneezing, coughing |
| What are the three histamine receptors? | H1, H2, H3 |
| What are the characteristics of H1 histamine receptors? | located on vascular, repiratory, & GI smooth muscle |
| What are the characteristics of H2 histamine receptors? | regulation of gastric acid secretion |
| What are the characteristics of H3 histamine receptors? | local regulation of histamine release??? (don't know a lot) |
| What are qualities of histamine H1 receptor activation? | increase permeability, drops blood pressure, contracts the bronchioles, nerve endings: pain & itch, temperature regulation, arousal, appetite, pain perception |
| What are qualities of histamine H2 receptor activation? | increases heart rate, drops blood pressure, RELAXES bronchioles, gastric acid secretion, temperature regulation, pain perception |
| What are qualities of histamine H1 blockers? | classical type (i.e. allergies), first generation vs. second generation (newer non-sedating) |
| What are qualities of histamine H2 blockers? | inhibits gastric acid secretion, relieve symptoms of ulcer |
| What are some uses for a histamine H1 blocker? | common cold-symptomatic relief, local allergic manifestations, motion sickness, sedative/hypnotic |
| What are some major classes of H1 blockers? | First generation: penetrate CNS/more side effects (blurred vision, dry mouth, etc); Second generation: newer: less sedating |
| What are the characteristics of first generation histamine blocker: Diphenhydramine (Benadryl)? | allergies, antiemetic, available OTC, causes sedation in 50% patients, peak levels in about 1 hour & lasts 4 hours |
| What are the characteristics of first generation histamine blocker: Dimenhydrinate(Dramamine)? | used for motion sickness, causes muscular weakness/drowsiness |
| What are characteristics of second generation histamine blocker: Terfendadine & Astemizole? | allergies, both cause toxic cardiac problems, terfenadine has to be metabolized to an active compound that builds up |
| What are characteristics of second generation histamine blocker: Fexofenadine (Allegra)? | allergies, causes less drowsiness, active metabolite of terfenadine so does NOT cause toxic cardiac effects |
| What are characteristics of second generation histamine blocker: Loratidine (Claritin)? | allergies, less sedating, once per day, extended release formulas |
| What are uses of histamine H2 blockers? | inhibit gastric acid secretion, reduce volume of gastric acid secretion, relief symptoms of peptic ulcers, GERD (gastroesophageal reflux) |
| What are characteristics of histamine H2 blocker: Cimetidine (Tagament)? | inhibits cytochrome P450 metabolism of other drugs; causes headaches, impotence, gynecomastia; better meds available |
| What are characteristics of histamine H2 blocker: Ranitidine (Zantac) & Famotidine (Pepcid)? | heartburn & gastric acid relief & Zollinger-Ellison Syndrome (excess HCl in stomach) |
| Hormones: | synthesized and released into the blood; then transported to a distant organ where it binds to a receptor |
| What are three types of hormones? | endocrine, paracrine, neurocrine |
| Are steroids hydrophilic or hydrophobic? | hydrophobic |
| What do the adrenocortical steroid horomones: glucocorticoids do? | influence carbohydrate metabolism |
| What do the adrenocortical steroid hormones: mineralocorticoids do? | modulate salt & water balance |
| What do the adrenocortical steroid hormones: androgens do? | expression of sexual characteristics |
| What is the name for referring to both glucocorticoids/mineralocorticoids? | corticosteroids |
| What do steroid hormones synthesize from? | cholesterol |
| What are some characteristics of anabolic steroids? | derivatives of testosterone, exogenous testosterone often used by athletes |
| What are some characteristics of corticosteroids? | steroid hormones, produced in the adrenal cortex, athletes using anabolic steroids may try to mask habit with corticosteroids |
| What are the four components of the hypothalamic-pituitary interface as related to corticosteroid biochemistry? | 1. Environmental factors stimulate hypothalamus to release corticotropin releasing hormone (CRH) 2. Factors travel to anterior pituitary to increase or decrease adrenocorticotropic hormone (ACTH) 3. anterior pituitary releases hormone into systemic circu |
| What are the four main components of the hypothalamic-pituitary axis? | Hypothalamus-->Anterior Pituitary-->Target gland-->hormone |
| The adrenal gland produces mineralocorticoids in the ______cortex & glucocorticoids in the _____cortex. | outer; inner |
| What are some characteristics of glucocorticoids? | increase availability of glucose, cortisol is most important, hydrocortisone, prednisone, & prednisolone |
| What are general physiological effects of glucocorticoids? | supply the brain with glucose, promote glucose availability, opposite effects of insulin |
| What are nine specific physiological effects of glucocorticoids? | 1. promote protein breakdown providing amino acids for glucose synthesis: high levels for prolonged time leads to thin skin, muscle wasting 2. promote fat breakdown: high levels for prolonged time leads to fat distribution (moon face/buffalo hump) 3. ma |
| How are glucocorticoids regulated? | synthesized when needed; not stored, synthesis controlled by adrenocorticotropic hormone (ACTH) (90% bound in plasma, need to free to work, increase blood glucose, metabolized in liver) |
| What are some characteristics of mineralocorticoids? | influence renal processing of sodium, potassium, & hydrogen; aldosterone most important |
| What are some physiological effects of mineralocorticoids? | aldosterone promotes sodium reabsorption & potassium/hydrogen excretion (without aldosterone: hyperkalemia, acidosis, dehydration, decreased extracellular fluid) |
| How are mineralocorticoids regulated? | by the renin-angiotensin system (NOT ACTH); possess salt-retaining properties |
| What are the two types of adrenocortical hormone diseases? | Adrenal hormone excess, insufficiency |
| What are some characteristics of Cushing's syndrome? | adrenocortical hormone excess of glucocorticoids, obesity/muscle weakness/stretch marks/moon face/buffalo hump, radiation & surgery to treat |
| What are some characteristics of Primary Hyperaldosteronism? | adrenocortical hormone excess; excessive secretion of aldosterone; muscle weakness/metabolic alkalosis/hypokalemia (low potassium); surgery/aldosterone antagonist (spironolactone) to treat |
| What are some characteristics of adrenocortical insufficiency? | replacement therapy with corticosteroids; glucocorticoid always required & possibly mineralocorticoid; For glucocorticoid: hydrocortisone/cortisone; For mineralocorticoid: use fludrocortisone |
| What are some characteristics of hydrocortisone? | similar to cortisol; also has mineralocorticoid properties, generally safe in low doses |
| What are some characteristics of fludrocortisone? | only mineralocorticoid available for replacement therapy; also glucocorticoid activity; treats Addison's disease/hypoaldosteronism/congenital adrenal hyperplasia; if dose is too high: salt/water retention leads to weight gain, hypertension, hypokalemia, e |
| What are some characteristics of Addison's Disease? | deficiency of gluco/mineralocorticoids, weakness/pigmentation of skin/hyperkalemia/hypoglycemia, hydrocortisone/cortisone & add fludrocortisone for treatment |
| What are some characteristics of Congenital Adrenal Hyperplasia? | deficiency of enzymes for glucocorticoid synthesis; overcompensates with ACTH releasing androgens; increases masculization in girls; phallic enlargement in boys; adult height is diminished; glucocorticoid administration in order to stop androgen productio |
| What are other therapeutic uses for steroids? | adrenal insufficiency, sports injury: tendonitis, asthma, arthritis: prednisone (Rheumatoid, Osteoarthritis), allergic diseases, organ transplantation, pneumocystis carinii pneumonia in HIV, hyperthyroidism, pain management of cancer, alcohol hepatitis, m |
| What are some basic principles for steroid administration? | therapeutic dose will change in course of therapy, single dose is usually not harmful, prolonged therapy has lethal potential, abrupt discontinuation may be life threatening due to adrenal insufficiency |
| What must one be aware of with steroid drug use? | adrenal insufficiency/ disruption of pituitary-adrenal gland axis |
| What are some characteristics of tapering regimens for steroid drugs? | need to allow recovery of normal pituitary-adrenal response to endogenously produced corticosteroids; tapering dosage may be necessary over 2 months to 1 year; symptoms of withdrawl |
| What are the symptoms of withdrawl for corticosteroid drugs? | headache, dizzines, joint pain, nausea, vomiting, fever, hypoglycemia, hypotension |
| What are some considerations for corticosteroid use with acute injuries? | collision/fall/twist, tears lead to inflammation, NSAIDs commonly used, corticosteroids will not help in treating of acute soft tissue injuries |
| What are some considerations for corticosteroid use for chronic injuries? | rotator cuff tendonitis/tennis elbow/achilles tendonitis, treatment through NSAIDs/PT/rest, corticosteroids used for chronic soft tissue injuries |
| What are some characteristics of steroid injections? | mehanism unknown, generally last resort, not more than three to four injections per year because of side effects |
| What are some common conditions treated by steroid injections? | tennis elbow/golfer's elbow/joint pain of varying nature/bursitis of shoulder, hip, or knee, frozen shoulder, carpal tunnel syndrome, herniated disc & other back pain |
| What are some considerations for corticosteroid use for asthma? | inhaled corticosteroids for patients with moderate to severe asthma; reduce sensitivity of the airways to triggers & prevent swelling in airways |
| What are the least potent corticosteroid drugs for asthma? | Vanceril, Beclovent, Azmacort |
| What corticosteroid drug is of intermediate potency for asthma? | AeroBid |
| What corticosteroid drugs are the most potent for asthma? | Flovent, Pulmicort |
| What do side effects of corticosteroid drugs depend on? | route of administration |
| What adverse side effects of corticosteroid use relate to fluid electrolyte imbalances? | sodium retention, edema |
| What adverse side effects of corticosteroid use relate to the GI system? | nausea/vomiting, weight loss/gain |
| What endocrine side effects may occur as a result of corticosteroid use? | hypercortisolism (Cushing's disease), precipitation of diabetes |
| What cardiovascular side effect may occur as a result of corticosteroid use? | hypertension |
| What musculoskeletal side effects may occur as a result of corticosteroid use? | muscle pain or weakness; fractures |
| What neurological side effects may occur as a result of corticosteroid use? | headache, seizure |
| What possible impact could corticosteroid use have on bone mass? | decrease amount of calcium absorbed from food, exerts direct effect on cells responsible for bone maintenance (osteoclasts/osteoblasts) |
| What impact do corticosteroids have on blood glucose levels? | increase blood glucose levels |
| Can taking corticosteroids result in development of diabetes? | corticosteroid use can result in development of diabetes |
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mpost51
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