Adrenocorticoids

Question 1

concept: Why do you get vasoconstriction with mast cell degranulation

Answer 1

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

Question 2

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

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

SHARK

Answer 2

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)

Question 3

concept: Cortisol effect mania:

@ CNS?

think cushing sydnrome presentation

Answer 3

insomina, euphoria –> depression

Question 4

concept: Cortosial effect mania @ ICP

Answer 4

increased in large doses

Question 5

concept: Cortisol effect mania @ pituitary hormones

Answer 5

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

Question 6

concept: How does cortisol cause peptic ulcers?

Answer 6

stimulation of gastric acid

suppression of immune response to H pylori

Question 7

concept: affect of cortisol on blood stuff?

Answer 7

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

Question 8

List the synthetic glucocorticoids please

Answer 8

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

Question 9

Why is Beclamethasone special?

Answer 9

short t1/2

penetrats airway mucos - low systemic toxicity

Question 10

Routes of Admin for synthetic glucocorticoids @ topical

Answer 10

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

Question 11

Routes of Admin for synthetic glucocorticoids @ IM

Answer 11

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

Question 12

Routes of Admin for synthetic glucocorticoids @ aerosol

Answer 12

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

Question 13

MOA of mineralcorticoids

Answer 13

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

Question 14

Action of mineralcorticoids

Answer 14

promote Na reabsorption from renal tubule

promote K and H exretion from renal tubule

Question 15

What is Fludrocortisone?

Answer 15

synthetic corticosteroid

** most commonly presecribed salt retaining hormone

Question 16

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

Answer 16

HPM

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

Question 17

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

Answer 17

triamcinolone 5:0

IM, aersol, topical

Question 18

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

Answer 18

dexamethasone 30:0

Question 19

Treat Addison disease

Answer 19

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

Question 20

Treat acute adrenal insufficiency

Answer 20

parenteral hydrocortsone + correct fluid and elctrolyte abnormalities

can administer salt retaining hormone once hydrocortisone levels are reduced

Question 21

Treat CAH

Answer 21

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

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

Question 22

Treat cushing syndrome

Answer 22

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

Question 23

Treat aldosteronism/conns

Answer 23

spironolactone - inhibitor of mineralocorticosteroids

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

Question 24

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

Answer 24

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

Question 25

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

Answer 25

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

Question 26

DOC @ hodgkin lymphona

Answer 26

prednisone (4:0.3)

Question 27

DOC @ cerebral oedema

Answer 27

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

Question 28

DOC @ idiopathic orthostatic hypotension

Answer 28

fludrocortisone (10:250)

Question 29

A/se of synthetic corticosteroids five million

Answer 29

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

Question 30

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

Answer 30

K Ca vit D

Question 31

Contraindications of corticosteroids, listed from brain to toes

Answer 31

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

Question 32

Spironolactone for who is helpful?

Answer 32

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

Question 33

A/se spironolactone

Answer 33

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 ```

Question 34

MOA of mifepristone

Answer 34

antag @ glucocorticoid and progesterone receptor

Question 35

Cxl application of mifepristone

Answer 35

inoperable patients with ectpic ACTH syndrome and adrenal carcinoma

Question 36

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

Answer 36

mifepristone them | = inhibits glucocorticoid receptors and progesterone receptors

Question 37

Tx adrenal cancer

Answer 37

aminoglutethimide : blocks conversion of cholesterol to pregnenalone and hydrocortisone or dexamethasone

Question 38

MOA of ketoconazole

Answer 38

potent and nonselective inhibitor of adrenal and fonadal steroid synthesis

Question 39

What could you treat using ketoconazole

Answer 39

cushing syndrome | prostate cancer

Question 40

MOA of metyrapone

Answer 40

relatively selective inhibitor of 11 hydroxylation = cortisol and corticosterone synthehsis

Question 41

Cxl app of metyrapone

Answer 41

tests adrenal function | PREGOS @ cushing

Question 42

DOC cushing

Answer 42

ketoconazole

Question 43

DOC cushing @ pregos

Answer 43

metyrapone

Question 44

Metyrapone B verses R please

Answer 44

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 :)