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Flashcards in Adrenocorticoids Deck (44):
1

concept: Why do you get vasoconstriction with mast cell degranulation

prevents degranulation of mast cells - - no histaomine -- overal increased toen in blodo vessels - - vasoconstriction

2

~*~Describe the anti-inflammatory MOA of cortisol/hydrocortisone

in lecture, she said that this information ''is very testable on USMLE;;

SHARK

1) inhibits phospholipase A3 (induction and activation of annexin I**) -- blocks arachidonic acid release -- no PGs
2) COX2 - reduced via inhibition of NfkappaB
3) INDUCES MAPK phosphatse I (inhibits MAPK activated proinflmmatory singlaing pathways)

3

concept: Cortisol effect mania:

@ CNS?

*think cushing sydnrome presentation*

insomina, euphoria --> depression

4

concept: Cortosial effect mania @ ICP

increased in large doses

5

concept: Cortisol effect mania @ pituitary hormones

suppresses ACTH - bc already too much of it around
suppresses GH - because you shouldnt be growing if you are too stressy, got other stuff to deatl with
suprresses TSH - thyroid hormones make you more crazy, dont help you relax
suppresses LH - sexy time in stressy time only sometimes a fun game

6

concept: How does cortisol cause peptic ulcers?

stimulation of gastric acid
suppression of immune response to H pylori

7

concept: affect of cortisol on blood stuff?

increases platelets and rbc and traps PMN, T cell and B cell in the blood.....why?

8

List the synthetic glucocorticoids please

B-D-MPT (b d empty)
B- beclamethasone
D - dexamethaose
M - methylprednisone
P - prednisone
T - triamcinolone

9

Why is Beclamethasone special?

short t1/2
penetrats airway mucos - low systemic toxicity

10

Routes of Admin for synthetic glucocorticoids @ topical

BDEMT
B-beclomethasone
D- dexamethasone
E - no
M- no
T- triamcinoilone
and hydrocortisone
BDxxT

11

Routes of Admin for synthetic glucocorticoids @ IM

BDMPT
B - no
D - no
E - no
M -no
P - no
T- triamcinolone
xxxxT

12

Routes of Admin for synthetic glucocorticoids @ aerosol

BDMPT
B - beclomethasone
D - no
M - no
P - no
T - triamcinolone
BxxxT

13

MOA of mineralcorticoids

increased expression of a) Na/K ATPase and b) ENaC

14

Action of mineralcorticoids

promote Na reabsorption from renal tubule
promote K and H exretion from renal tubule

15

What is Fludrocortisone?

synthetic corticosteroid

** most commonly presecribed salt retaining hormone

16

Name the short to medium acting glucocorticoids and their anti inflam versys salt retaining ratios (just a guestimate)

HPM

hydrocortisone 1:1
prednisone 4:small
methylprednisolone 5: small

17

Name the intermediate acting glucocorticoids and teir anti inflamm vers salt retainining ratios (guesstimate only is okay)

triamcinolone 5:0

IM, aersol, topical

18

Name the long-actign glucocorticoids adn either anti inflamm vrs salt retaning ratios (guesstimate is okay)

dexamethasone 30:0

19

Treat Addison disease

daily hydrocortisone (short to medium with 5: low) + mineralcorticoide (fludrocortisone)

DO NOT GIVE: long acting glucocorticoids (Dexamethasone) or onces that lack salt reatining effects (Trimcinalone and dexamethasone)
rememebr: addisons has no aldosterone and cortisol so presentation = hypotension, hypoglycemia, weak, fatigue, weight loss etc

20

Treat acute adrenal insufficiency

parenteral hydrocortsone + correct fluid and elctrolyte abnormalities

can administer salt retaining hormone once hydrocortisone levels are reduced

21

Treat CAH

treat as an adrenal crsis = fluid and electroylyte replensihment and hydrocorticosterone

once stabilized --> oral hydrocortisone (5:0.25)/prednisone (4:0.3) AND fludrocortisone

22

Treat cushing syndrome

surgical removal of tumour, irradiation of pituitary tumor or resection of one of both adrenals
**before surgery give high dose cortisol same with after surgery - decreased dose slowly to prevent withdrawal

23

Treat aldosteronism/conns

spironolactone - inhibitor of mineralocorticosteroids

clinical presentation - aldosterone going crazy = sucking up too much na (water) and spitting out to much K and H

24

Who cares abotu teh Dexamethasone suppression test (30:0)

will suppress at high levels a pituitary dependent cushing syndrome but not an ectopic adrenal spewing out tumor

25

Premature infant on its way, what do you want to do?

IM steroids for mom ie dexamethasone (30:0) to help mature lungs

26

DOC @ hodgkin lymphona

prednisone (4:0.3)

27

DOC @ cerebral oedema

dexamethasone (30:0) = dont want to retain any more salt/water -- or bad news bears all over the place

28

DOC @ idiopathic orthostatic hypotension

fludrocortisone (10:250)

29

A/se of synthetic corticosteroids

five million

a) metabolic effects ie cushing syndrome
b) peptic ulcer (bc stimulates gastrin and may decreased immuno vrs H pylor)
c) can mask symptoms of other diseaseas (bacterial an mycobacterial inection; keeps all the blood cells in the blood)
d) myopathy @ long acting
e) nauseua, dizzy, weight loss
f) euphoria, psychosis, depression
g) increased ICP (treat cerebral oedema with)
h) posterior subcapsular cataracts
i) sodium and fluid rentention, loss fo potassium
i) growth retardation
j) adrena suppression

30

What supplements to give to patient to ease a/se of peopel on corticosteroids

K
Ca
vit D

31

Contraindications of corticosteroids, listed from brain to toes

psychoses
glaucoma
heart disease/hypertenion with heart failure
peptic ulcer
osteoporosis
TB/zoster infections
diabetes

32

Spironolactone for who is helpful?

aldosterosim - dx and tx
hirsuitism in women - androgen antag
diuretic

33

A/se spironolactone

OPP OF ALDOSTERONE

= hyperkalemia (bc not spewing it out)
= cardiac arrhtymia (from the hyperkalemia)
= menstrual abnormalities
= gynecomastia (anti androgen)
sedation - i dont know
headache - i dont know
gi disturbances - mayeb elctrolyte and water stuffs
skin rash - i dont know

34

MOA of mifepristone

antag @ glucocorticoid and progesterone receptor

35

Cxl application of mifepristone

inoperable patients with ectpic ACTH syndrome and adrenal carcinoma

36

How are you going to help a pateitn who has an inoperable ectopic ACTH carcinoma?

mifepristone them
= inhibits glucocorticoid receptors and progesterone receptors

37

Tx adrenal cancer

aminoglutethimide : blocks conversion of cholesterol to pregnenalone

and hydrocortisone or dexamethasone

38

MOA of ketoconazole

potent and nonselective inhibitor of adrenal and fonadal steroid synthesis

39

What could you treat using ketoconazole

cushing syndrome
prostate cancer

40

MOA of metyrapone

relatively selective inhibitor of 11 hydroxylation = cortisol and corticosterone synthehsis

41

Cxl app of metyrapone

tests adrenal function
PREGOS @ cushing

42

DOC cushing

ketoconazole

43

DOC cushing @ pregos

metyrapone

44

Metyrapone B verses R please

benefits - can be used to treat prego women cushing syndrome and test adrenal function

R: salt wand water retention, hirsutism, transient dizziness, gi disturbances = thses make no sense inmy brain. memo

salt and water = aldosterone
hirsutisim - androgens
transient dizziness
gi disturbances

:)