adrenocorticosteroids

Question 1

mifepristone

Answer 1

gluocorticoid antagonist

Question 2

spirnolactone

Answer 2

mineralcorticoid antagonist

Question 3

ketoconazole

Answer 3

corticosteroid synthesis inhibitor

Question 4

aminoglutehimide

Answer 4

corticosteroid synthesis inhibitor

Question 5

metyrapone

Answer 5

corticosteroid synthesis inhibitor

Question 6

fludrocortisone

Answer 6

mineralcorticoid agonist

Question 7

major effects of cortisol

Answer 7

1) gluconeogenesis and 2) glycogen synthesis = maintains hepatic glycogen in fasting state
- - inc glucose levels

stimulate lipolysis

stimulate protein catabolism

net = maintain adequate glucose to brain

catabolic effects = wasting to lymphoid, CT, muscle, fat, skin, osteoporosis, growth retardation

immunosuppressive =

• inc neutrophils (inc influx and dec migration form BV)
• dec lymphocytes, monocytes, eosinophils, basophils
• vasoconstriction - d/t mast cell degranulation

anti-inflamm

• inhibit PLA2 - blocking arachidonic acid, COX2
• induction of MAPK-phosphatase 1

CNS: behavioral changes - insomnia/euphoria
Inc ICP
Suppress ACTH, growth hormone, TSH, LH
Peptic ulcers (stimulate gastric acid and suppress immune response to h. pylori)

• Inc platelets, RBC
• renal function is impaired with cortisol deficiency
• develop fetal lungs

Question 8

which glucocorticoid has a short t 1/2

Answer 8

beclomethasone

- penetrates airway mucosa

Question 9

which glucocorticoid can be given IM

Answer 9

triamcinolone

Question 10

which 2 glucocorticoids can be given with aerosol

Answer 10

beclomethasone
triamcinolone

good for asthma, or pt that you don’t want to systemic effects

Question 11

which glucocorticoids can be given systemic

Answer 11

beclomethasone
dexamethasone
hydrocortisone
triamcinolone

Question 12

mineralocorticoids MOA

Answer 12

inc expression of Na/K ATPase and ENaC

• promote Na reabsorption from renal tubule
• promote K and H excretion

Question 13

short to medium acting glucocorticoids

Answer 13

hydrocortisone
prednisone
methylprednisolone

Question 14

intermediate acting glucocorticoid

Answer 14

traimcinolone

Question 15

long acting glucocorticoid

Answer 15

dexamethasone

Question 16

which glucocorticoid has 1:1 anti inflamm to salt retaining

Answer 16

hyrocortisone

Question 17

which glucocorticoids has 0 salt retaining effects

Answer 17

triamcinolone
dexamethasone

these wouldn’t be good for addison’s (loss of both gluoccorticoid and mineracorticoid)

Question 18

treat addison’s

Answer 18

daily hydrocortisone (increase before stress) + mineralocorticoid (fludrocortisone)

don’t give glucocorticoids lacking salt retaining effects**

Question 19

tx ACUTE adrenocortical insufficiency

Answer 19

large amoutns of parenteral hydrocortisone + correction of fluid, electroyltes

can give fludrocortisone once hydrocortisone levels are reduced

Question 20

tx congenital adrenal hyperplasia

Answer 20

intially: treat like acute adnreal crisis

once stabilized = oral hydrocortisone/prednisone + fludrocortisone

Question 21

tx cushings syndrome

Answer 21

remove tumor
radiation
resection of both adrenals

tx with high doses of cortisol before and after surgery - slowly decrease to prevent withdrawal

Question 22

tx alodsteronism

Answer 22

spirnolactone

Question 23

lung maturation in fetus

Answer 23

IM dexamethasone

Question 24

hodgkins lymphoma tx

Answer 24

prednisone

Question 25

cerebral edema tx

Answer 25

dexamethasone

Question 26

idiopathic orthostatic hypotension tx

Answer 26

fludrocortisone

Question 27

corticosteroid AE

Answer 27

``` metabolic - cushingoid, DM, osteoporosis peptic ulcers infections myopathy (long term) CNS - euphoria increased IOP subcapsular cataracts growth retardation adrenal suppresion ``` **abrupt withdrawal can cause adrenal insufficiency

Question 28

corticosteroid contraindication

Answer 28

``` peptic ulcers HTN, HF TB, zoster infection psychoses DM osteoporosis glaucoma ```

Question 29

spirnolactone

Answer 29

competitive antagonist = decreases effect peripherally use = aldosteronism, hirsutism, diuretic

Question 30

spirnolactone AE

Answer 30

hyperkalemia cardiac arrythmias gynecomastia rash

Question 31

mifepristone use

Answer 31

inoperable pt with ectopic ACTH syndrome or adrenal carcinoma

Question 32

aminogluthethimide

Answer 32

corticosteroid synthesis inhibitor block conversion of cholesterol to preneolone = reduce synthesis of all hormonally active steroids

Question 33

aminoglutethimide use

Answer 33

adrenal cancer (+ hydrocortisone/dexamethasone)

Question 34

ketoconazole use

Answer 34

cushing's syndrome | prostate cancer

Question 35

metyrapone

Answer 35

selective inhibitor of steroid 11 hydroxylation = interferes with cortisol and corticosterone synthesis

Question 36

metryapone use

Answer 36

tests adrenal function | tx pregnant women with cushing's

Question 37

tx pregnant female with cushing

Answer 37

metyrapone

Question 38

metyrapone AE

Answer 38

salt and water retention hirsutism transient dizziness GI disturbances