Corticosteroids

  1. Five oral corticosteroids approved in the US are Beclomethasone dipropionate (QVAR), flunisolide (Aerobid), flunisolide hemihydrate HFA (AeroSpan), fluticasone propionate (Flovent) and budesonide (Pulmicort).
  2. The major therapeutic effect of corticosteroids is their anti inflammatory action such as bone loss (osteoporosis), significant weight gain, acne, cataracts, increased susceptibility to infection due to suppressed immune system, psychosis, bruising, thinning of the skin, hair growth, anxiety, insomnia, headaches, mood swings and stunted growth in children .
  3. Both COPD and Asthma can be treated for inflammation using corticosteroids.
  4. The assumption is that inhaled corticosteroids would have a local effect and not any systemic effects like oral drugs have, thus not interfering with the body’s endogenous (the body’s own) corticosteroid regulation.
  5. Beta agonists relieve the early phase of bronchoconstriction in asthma, while the corticosteroids are effective in both early and late stage relief of asthmatic bronchoconstriction.
  6. Oral corticosteroids generally depress the endogenous regulatory activity (HPA) resulting in a variety of related imbalances; growth in children is blocked, bone density is decreased, adrenal steroid secretion compromised, etc.
  7. Since oral steroid use suppresses the patient’s indigenous corticosteroid secretion, care should be taken to taper off the oral therapy while administering aerosolized therapy. This would allow the endogenous secretions to resume gradually.
  8. Oral thrush is a common side effect of inhaled steroids.
  9. The way to reduce thrush is to direct the steroid to the lung bronchi away from the oropharynx. This can be done with a reservoir device on the MDI. Also rinsing the mouth will prevent corticosteroid buildup in the oropharynx.
  10. Inhaled corticosteroids do not act fast enough to be an effective therapy against acute onset asthma. They are a good compliment to fast acting beta adrenergics for longer term management of asthma.

Prompt
For your final assignment create a final review guide with common medications which we discussed in both BIO141 and BIO142. Group medications according to their classification and mode of action. You can use the following example to guide your efforts. Neonatal and Pediatric Pharmacology and Corticosteroids have been completed for you.
This final review will be used by you for the remainder of the RT program at IU. Please save a copy and add to it as you go.
Neonatal and Pediatric Pharmacology

  1. Surfactant Therapy
    A. Indications:
    a. Premature infants born less than 37 weeks’ gestation who have not reached lung maturity
    b. Respiratory Distress Syndrome (RDS)
    B. Precautions:
    a. Obstruction of endotracheal tube by surfactant
    C. Natural surfactant agents:
    a. Calfactant (Infasurf)
    b. Beractant (Survanta)
    c. Poractant Alfa (Curosurf)
    D. Exogenous surfactant agents:
    a. Lucinactant (Surfaxin)
    b. Colfosceril palmitate (Exosurf)
  2. Methylxanthines
    A. Indications:
    a. Apnea
    B. Common methylxanthines
    a. Theophylline
    b. Caffeine

C. Antiviral
D. Indications:
a. Respiratory Syncytial virus (RSV)
E. Inhaled antiviral medication:
a. Ribavirin (Virazole)
Corticosteroids
A. Action: anti-inflammatory, immunosuppressive agents
B. Indications:
a. Asthma
b. COPD
C. Precautions:
a. Oral candidiasis
b. Adrenal suppression
c. Weight gain
D. Aerosolized Steroids:
a. Beclamethasone dipropionate HFA (QVAR)
b. Budesonide (Pulmicort)
c. Flunisolide (Aerobid)
d. Fluticasone (Flovent)
E. Non-Aerosolized Steroids:
a. Prednisone
b. Cortisone (Hydrocortisone)
c. Methylprednisolone (Solu-Medrol)
Submit your answers in at least 500 words on a Word document. You must cite at least three references in APA format to defend and support your position.

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