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Pharm II > Corticosteroids > Flashcards

Corticosteroids Flashcards

1
Q

What drug/ hormone is a mineralocorticoid?

A

Aldosterone

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2
Q

What drug/ hormone is a glucocorticoid?

A

Cortisol

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3
Q

What is aldosterone regulated by?

A

ATII and K+

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4
Q

What is cortisol regulated by?

A

ACTH

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5
Q

What are the 2 main effects of aldosterone?

A

↑ Na+ and H2O retention and ↑ K+ excretion

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6
Q

What does cortisol exert a negative feedback effect on?

A

CRH = ↓ ACTH

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7
Q

Is cortisol a short or long acting stress hormone?

A

Long acting (acts via nuclear receptors)

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8
Q

Does cortisol favor catabolic or anabolic processes?

A

Catabolic (favors energy release) (↑ circulating glucose, FFA, AA)

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9
Q

Cortisol antagonizes the effects of what hormone?

A

Insulin

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10
Q

How does cortisol play a role in fat redistribution?

A

Redistribution of fat centrally

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11
Q

What are the CV effects of cortisol (2)

A

↑ vascular responsiveness to sympathetic stimulation b/c inhibition of catecholamine re-uptake (more catecholamines in cleft = more effects), ↑ CO

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12
Q

Cortisol has endocrine effects by decreasing what hormones?

A

GH, TSH, LH

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13
Q

Cortisol has endocrine effects by increasing what hormone?

A

Epi

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14
Q

How does cortisol lead to bone destruction over time? (2)

A

Inhibits action of vit. D → ↓ Ca deposition ↑ PTH → ↑ Ca loss from bone

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15
Q

What are the effects of cortisol on the immune system?

A

Immunosuppressive, anti-inflammatory, suppression of wound healing (early and late stages)

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16
Q

What effects can cortisol have on the CNS, although there is individual variance? (5)

A

Mood elevation, insomnia/ restlessness, anxiety, depression, psychosis

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17
Q

What is the possible GI related SE of cortisol?

A

Peptic ulcer development

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18
Q

Is Cushing’s glucocorticoid excess or insufficiency?

A

Excess

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19
Q

What is the cause of Cushing’s disease?

A

Excess ACTH due to tumor in the pituitary gland

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20
Q

What is the cause of Cushing’s syndrome?

A

Excess cortisol due to anything else besides ACTH secreting pituitary tumor

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21
Q

What is the most common cause of Cushing’s syndrome?

A

Exogenous glucocorticoids (could also be a tumor)

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22
Q

What are the following sxs associated with?

Buffalo hump, thinning of skin, thin arms, moon face, increased abdominal fat, striae, easy bruising, poor wound healing

A

Cushing’s

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23
Q

What test is performed for the diagnosis of Cushing’s after a low dose dexamethasone suppression test?

A

High dose dexamethasone suppression test

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24
Q

For the high dose dexamethasone suppression test, you measure baseline cortisol levels in AM, administer dexamethasone in the PM, then measure levels again when?

A

The following morning (when it should be the highest due to circadian release)

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25
Q

On the high dose dexamethasone suppression test, extreme suppression of cortisol indicates what?

A

Normal

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26
Q

On the high dose dexamethasone suppression test, cortisol levels 50% suppressed indicate what?

A

Cushing’s disease

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27
Q

On the high dose dexamethasone suppression test, unchanged cortisol levels indicate what?

A

Cushing’s syndrome

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28
Q

Addison’s disease, adrenal malfunction, and pituitary malfunction lead to adrenocortical excess or insufficiency?

A

Insufficiency

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29
Q

What are the sxs of adrenocortical insufficiency? (4)

A

Hyperpigmentation, salt craving, anorexia, weight loss

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30
Q

Acute adrenal insufficiency is aka?

A

Addisonian crisis

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31
Q

Circulatory collapse, dehydration, vomiting, hyperkalemia, and the possibility of these sxs to be fatal is what condition?

A

Addisonian crisis

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32
Q

Condition in which the body is unable to repond to acute high stress so need exogenous mineralocorticoid to appropriately respond to stress is what?

A

Addisonian crisis

33
Q

Ketoconazole drug class?

A

Corticosteroid synthesis inhibitor

34
Q

Mifipristone drug class? (corticosteroids)

A

Receptor antagonists

35
Q

Spironolactone drug class (corticosteroids)

A

Receptor antagonists

36
Q

What is the relative mineralocorticoid (salt-retaining) and glucocorticoid (anti-inflammatory) activity of hydrocortisone and cortisone?

A

Equal activity

37
Q

What is the relative mineralocorticoid (salt-retaining) and glucocorticoid (anti-inflammatory) activity of prednisone and prednisolone?

A

Glucocorticoid > mineralocorticoid

38
Q

What is the relative mineralocorticoid (salt-retaining) and glucocorticoid (anti-inflammatory) activity of methylprednisolone and triamcinolone?

A

Virtually no mineralocorticoid activity

39
Q

Is hydrocortisone or cortisone inactive?

A

Cortisone inactive, 80% potency

40
Q

Is prednisone or prednisolone inactive?

A

Prednisone

41
Q

What is the primary use of hydrocortisone and cortisone?

A

Replacement therapy for adrenal insufficiency

42
Q

What is the duration of hydrocortisone and cortisone?

A

Short duration (8-12 hours)

43
Q

What is the primary use of prednisone and prednisolone?

A

Anti-inflammatory effects (with minor salt-retaining effects)

44
Q

What is the duration of prednisone and prednisolone?

A

Intermediate duration (12-36 hours)

45
Q

What is the use of methylprednisone and triamcinolone?

A

Anti-inflammatory (with no salt-retaining effects)

46
Q

What is the duration of methylprednisone and triamcinolone?

A

Intermediate duration (12-36 hours)

47
Q

What is the use of dexamethasone and betamethasone?

A

Anti-inflammatory (with no salt-retaining effects)

48
Q

What is the duration of dexamethasone and betamethasone?

A

Long duration (36-72 hours)

49
Q

What is the use of fluticasone?

A

Most commonly prescribed inhaled mineralocorticoid

50
Q

What is the use of aldosterone?

A

Salt-retaining with minimal anti-inflammatory effects

51
Q

What is the use of fludrocortisone?

A

Salt retaining with minimal anti-inflammatory effects

52
Q

What is the use of oral corticosteroids?

A

High dose/ long-term therapy or replacement therapy

53
Q

What is the use of corticosteroid injections?

A

Emergencies or depot administration

54
Q

What is the use of inhalation/ intranasal corticosteroids?

A

Asthma and rhinitis

55
Q

What are the 3 notable properties/ effects of topical corticosteroids?

A

Insoluble (prevents absorption), more potent used on thick skin only (if skin damage/ thin skin → systemic absorption), repeated application = depot effect

56
Q

What is the danger about acute adrenal insufficiency?

A

Can be life threatening

57
Q

When will you see increased amounts of corticosteroids?

A

Stress or infection

58
Q

What is the DOC for initial treatment of asthma?

A

Inhaled glucocorticoid

59
Q

Why are corticosteroids used in the treatment of RA?

A

Decrease inflammation

(used in inflammatory conditions in general)

60
Q

What therapeutic guideline should be followed for corticosteroid treatment with respect for amount of time and dose given?

A

Only as long as necessary at lowest effective dose

61
Q

Should you start corticosteroid treatment at a high or low dose?

A

Start at higher dose, taper down once inflammation is under control

62
Q

Should corticosteroids be used locally or diffuse?

A

Locally whenever possible

63
Q

Should corticosteroids be given daily or an alternate days?

A

Alternate days

64
Q

When are corticosteroids most likely to cause adverse effects and result in suppressed HPA (for months)?

A

Chronic or high dose

(short term therapy (1-2 weeks) is not likely to cause serious problems)

65
Q

What is the worst adverse effect of corticosteroid treatment that limits therapeutic effects?

A

Osteoporosis

66
Q

How does corticosteroid treatment affect infection?

A

Masks sxs of infection/ makes more susceptible to infection (this can lead to serious infection)

67
Q

How can corticosteroid treatment after diabetes pts?

A

Hyperglycemia (may “unmask” DM in some pts)

68
Q

What are some of the adverse CNS effects seen with corticosteroid treatment? (seen with acute or chronic txs)

A

Restlessness, insomnia, psychosis, increased appetite

69
Q

Why should you avoid abrupt cessation or more than 1-2 weeks of high dose therapy with corticosteroids? (2)

A

Induce adrenal insufficiency/ HPA depression

Can cause cushingoid SEs

70
Q

How can corticosteroid treatment affect chronic pts?

A

Stress intolerance

71
Q

When are there no contraindications to corticosteroid treatment?

A

Adrenal insufficiency

72
Q

The following are contraindications to what?

Systemic bacterial or viral infection, poorly controlled DM, osteoporosis, heart disease or HTN w/ CHF, IMC, pregnancy, childhood

A

Corticosteroid treatment with NO adrenal insufficiency

73
Q

What is the MOA of ketoconazole besides antifungal?

A

Inhibits steroidogenesis (cortisol) production at high doses

74
Q

What is the DOC in pre-surgical Cushing’s pts?

A

Ketoconazole

75
Q

What are the SEs of ketoconazole? (4)

A

Reversible hepatotoxicity, gynecomastia, libido decrease, impotence

76
Q

What is the contraindication to ketoconazole?

A

Pregnancy

77
Q

What are the basic MOAs for spironolactone besdies potassium sparing diuretic? (as corticosteroid)

A

Mineralocorticoid, anti-androgen

78
Q

What are the uses for spironolactone (corticosteroids)? (2)

A

Hyperaldosteronism, hisutism

Pharm II (13 decks)

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