5 - Corticosteroids Flashcards by G V

Glucocorticoids is?

Cortisol

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Mineralocorticoids is?

Aldosterone

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Sex steroids are? (3)

Dehydroepiandrosterone (DHEA)

Androstenedione

Testosterone

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GFR =

Salt (G)

Sugar (F)

Sex (R)

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Circadian rhythm of cortisol secretion: Highest and lowest when?

Highest in morning

Lowest in evening

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Mineralocorticoid Actions (2)

Increases Na+ reabsorption from the DCT and CD

Increases K+ and H+ excretion in urine

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Glucocorticoid Actions: Carbohydrate (2)

Promotes gluconeogenesis

Inhibit peripheral utilization and stimulating release of glucose from liver

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Glucocorticoid Actions: Proteins (3)

Catabolic action –> increased breakdown-bone, muscle, fat, skin

Mobilization of amino acids for glucose production

Negative nitrogen balance

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Glucocorticoid Actions: Fat (2)

Promotes lipolysis

Redistribution of body fat

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Glucocorticoid Actions: Lymphoid Tissue (1)

Increased rate of destruction of lymphoid cells

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Glucocorticoid Actions: CVS (1)

Decreases capillary permeability

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Glucocorticoid Actions: Inflammation (3)

Limitation of recruitment of inflammatory cells

Suppressive effects on the inflammatory cytokines and chemokines

Inhibit PLA2, reduce the expression of COX2 - reducing production of PGs, LTS

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Glucocorticoid Actions: Immunity (4)

Inhibit the functions of macrophages and antigen presenting cells

Inhibition of IL-1 release from macrophages “

Inhibition of IL-3 formation and action

Suppression of NK cells

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Manifestatons of Excess Cortisol (8)

Increased protein catabolism = striae, bruising, delayed wound healing, muscle wasting
Increased glucose production = DM
Redistribution of fat = truncal obesity
Bone breakdown = osteoporosis
Facilitation of catecholamines = hypertension
Anti-inflammatory = opportunistic infections
Inhibition of HPG axis = amenorrhea, impotence
CNS effects (limbic/hippocampus) = depression and memory difficulties

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Cushing’s Syndrome Defined

Constellation of findings due to hypercortolism of ANY SOURCE

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Cushing’s Disease Defined

Most common NON-IATROGENIC cause of Cushing’s Syndrome is PITUITARY ADENOMA

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Adrenal Glucocorticoids: Short to Medium-Acting Gluocorticoids Drugs (5)

Hydrocortisone (cortisol)
Cortisone
Prednisone
Prednisolone
Methylprednisolone

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Adrenal Glucocorticoids: Intermediate-Acting Glucocorticoids Drugs (2)

Triamcinolone

2. Paramethasone

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Adrenal Glucocorticoids: Long-Acting Glucocorticoids (2)

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Betamethasone

2. Dexamethasone

Mineralocorticoids Drugs (2)

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Fludorocortisone

2. DesOxycortiCosterone Acetate

Topical Steroid Preparations (3)

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Beclomethasone
Budesonide
Fluticasone

Corticosteroid Use: Replacement Therapy - Acute Adrenal Insufficiency: Defined (2)

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Life-threatening characterized by GIT sx –> NV, and ab pain

Dehydration, hyponatremia, hyptension, weakness, lethargy, HYPERkalemia

Corticosteroid Use: Replacement Therapy - Acute Adrenal Insufficiency: Rx (3)

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IV therapy with ISOTONIC NaCl supplemented with 5% glucose
Corticosteroids –> IV bolus of hydrocortisone (cortisol) and continuous infusion
Appropriate therapy for precipitating causes such as infection, trauma, or hemorrhage

Corticosteroid Use: Replacement Therapy - Chronic Adrenal Insufficiency: Symptoms (4)

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Weakness
Fatigue
Weight loss
Hypotension

Corticosteroid Use: Replacement Therapy - Chronic Adrenal Insufficiency: Rx (2 statements)

Require daily tx with corticosteroids ALSO require mineralocorticoid replacement (fludrocortisone acetate)

Corticosteroid Use: Replacement Therapy - Congenital Adrenal Hyperplasia: Defined (3)

Mutations in CYP21, the enzyme that carries out the 21-hydroxylation reaction Classic CAH requires replacement therapy with hydrocortisone If salt wasting, also require mineralocorticoid replacement

Non-Endocrinal Uses: 5 Conditions without explanations

1. Rheumatoid Arthritis 2. Gout 3. Malignancies --> ALL and lymphomas 4. Organ transplanation 5. Cerebral Edema

Non-Endocrinal Uses: Collagen-Vascular Disorders (2)

Tx of more serious inflammatory rheumatic disease such as SLE Vasculitic disorders: GIANT CELL ARTHRITIS, PAN, Wegener's

Non-Endocrinal Uses: Severe Allergic Reactions (5)

1. Hay Fever 2. Serum sickness 3. Urticaria 4. Contact dermatitis 5. Angioneurotic edema

Non-Endocrinal Uses: Stimulation of Lung Maturation in the Fetus (2)

Tx of the MOTHER with large doses of GCs reduces the incidence of RESP DISTRESS SYNDROME in prematurely delivered infants Betamethasone

Non-Endocrinal Uses: Pulmonary Diseases (Bronchial Asthma) Drugs (6)

1. Beclomethasone 2. Dipropionate 3. Triamcinolone acetonide 4. Flucticasone 5. Flunisolide 6. Budesonide

Non-Endocrinal Uses: Renal Diseases (1)

1. Nephrotic Syndrome secondary to minimal change

Non-Endocrinal Uses: Eye Diseases (4)

1. Acute uveitis 2. Allergic conjunctivitis 3. Choroiditis 4. Optic neuritis

Non-Endocrinal Uses: Skin Diseases (4)

1. Eczematous skin disease 2. Exfoliative dermatitis 3. Pemphigus 4. Prurigo nodularis

Non-Endocrinal Uses: GIT Disease (1)

Inflammatory bowel disease for ACUTE flare ups

Non-Endocrinal Uses: Diagnostic Applications (1)

Dexamethasone Suppression Test for Cushing's Syndrome

Adverse Effects from Long-Term Use (10)

1. Peptic Ulcers 2. Osteoporosis 3. Preciptiation of diabetes, hypertension 4. Oedema 5. Glaucoma 6. Cataract 7. Fetal abnormalities 8. Muscle wasting 9. Immune response 10. Suppression of HPA axis

General Principles of Corticosteroids Therapy: For short period, use?

Short-acting, lowest possible dose

General Principles of Corticosteroids Therapy: Long term treatment --> HPA suppression and abrupt cession leads to? And how to prevent?

Abrupt cessation --> withdrawl syndrome --> malaise, fever, weakness, joint pain, reactivation of disease Prevent by gradual tapering of the dose over 1 week

General Principles of Corticosteroids Therapy: For infection, severe stress, and trauma, do what to dose?

Increase the dose (e.g. acute adrenal insufficiency

General Principles of Corticosteroids Therapy: Use what type of preparations?

Locally applicable preparations

Glucocorticoid Antagonists Drugs (3)

1. Metyrapone 2. Aminoglutethimide 3. Trilostane

Glucocorticoid Antagonists Drugs: Metyrapone (2)

Selective inhibitor of CYP11B1 Used in Cushing's Syndrome

Glucocorticoid Antagonists Drugs: Metyrapone Adverse Effects (2)

1. Hirsutism | 2. Oedema

Glucocorticoid Antagonists Drugs: Trilostane (1)

3-17 hydroxysteroid dehydrogenase inhibitor (inhibits step before last step)

Glucocorticoid Antagonists Drugs: Aminoglutethimide (3)

Primarily inhibits CYP11A1 (first step, conversion of cholesterol to pregneglone) Cushing's Syndrome Breast Cancer

Mineralocorticoid Antagonists (3)

1. Spironolactone for primary HYPERalodsteronism and hirsutism 2. Eplerenone --> approved for txing hypertenstion 3. Drospirenone --> used along with estrogen combo as OCP

5 - Corticosteroids Flashcards

(47 cards)