Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharm II > Adrenocorticosteroids and Adrenocortical Antagonists - DONE > Flashcards

Adrenocorticosteroids and Adrenocortical Antagonists - DONE Flashcards

(80 cards)

Start Studying
1
Q

65 yo White Male presents with Strongyloides in the lungs. He is currently on mechanical ventilation, hypotensive and hyponatremic.
A cosyntropin stimulation test indicates a inadequate response.

A

IV Hydrocortisone/Oral Fludrocortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

80 yo African American Female presents to clinic with history of CHF. She is currently receiving Furosemide 40 mg BID, Digoxin 0.125mg daily. Patient has 3 + pitting edema and DOE.

A

Spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hypothalamus secretes __ to act on the Anterior PItuitary thus secreting __ to act on the Adrenal glands

A

CRF

ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

After ACTH acts on the Adrenal glands, ___ Is released and has a negative feedback on what?

A

Cortisol

Negative feedback on Ant Pit and Hypothalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What external stimulates the HPA AXIS to increase release of cortisol?

A

Stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Regulation of the HPA axis is governed by ___

A

PVN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Parvocellular neurons contain both ___ and ____

A

CRF and Vasopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

__ elicits ACTH release from Anterior pituitary

A

CRF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

__ acts at the adrenal cortex to increase release and synthesis of glucocorticoids

A

ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 3 negative feedback effects of Stress on the HPA Axis?

A

Decrease hypothalamic CRF release
Decrease POMC transcription, ACTH secretion and CRF responsiveness
Decrease production in adrenal cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the negative feedback effect of ACTH on the HPA axis?

A

decrease hypothalamic CRF release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the 2 layers of the adrenal gland (including sublayers) and what is secreted from each??

A 
Cortex
  Zona Glomerulosa - Aldosterone
  Z. Fasciculta - Cortisol
  Z. Reticularis - Testosterone and Estradiol
Medula - Epi and Norepi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the name of the hormone steroid that secretes coritsol that effects metabolism and immune function?

A

Glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the name of the hormone steroid that secretes aldosterone and effects are salt retaining?

A

Mineralocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 3 types of Hormone Steroids?

A

Glucocorticoids
Mineralocorticoids
Androgenic/Estrogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What hormone has the following effects: Metabolism, Stress response, CV function, Immunity, Fetal Lung Maturation, and Regulated by CNS-negative feedback?

A

Cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

The 3 necessary sites of the glucocorticoid activity on coritcosterone are: (Just read these, I doubt she will ask them but just incase!)

A
  1. Hydroxyl group at C17 with associated C20-C21 side chain
  2. Hydroxyl group at C11
  3. Keto C3 and double bond between C4 and C5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How many Glucocorticoid receptors are there and which one has the greater affinity for glucocorticoids? greater affinity for mineralocorticoids?

A

2
equal for glucocorticoids
Type 1 for mineralocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Glucocorticoid receptors have biological activity through ___

A

alternations in DNA gene transcription

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does Glucocorticoid enter the cell? and then bind to a receptor and cause what?

A

Passive diffusion

Dissociation from HSP-90 (activates it)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What occurs after Glucocorticoid binds to a receptor inside the cell?

A

Dimerizes and translocate into the nucleus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

T/F GlucocorticoIds are absorbed rapidly from the GI because they are lipophilic.

A

TRUE!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

T/F Glucocorticoids are absorbed slowly through the skin.

A

TRUE!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

T/F Majority of glucocorticoids (90-97%) are plasma protein bound. If true, to what proteins and which one has a higher affinity?

A

TRUE
Cortisol-binding globulin and Albumin
Higher affinity for Cortisol-binding globulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Where are glucocorticoids metabolized?
``` Liver - Reduction of C4-C5 bond - Reduction of Keto at C3 - Hydroxylation at C6 Kidneys - 11 beta-hydroxysteroid dehydrogenase - Cortisol -> Cortisone ```
26
What metabolic effects of cortisol are INCREASED?
- increase in plasma glucose by glycogenolysis and gluconeogenesis - increase lipolysis - increase protein catabolism
27
What metabolic effects of cortisol are DECREASED?
- decrease uptake of amino acids and protein synthesis - decrease Ca absorption from GI - decrease thyroid-stimulating hormone secretion
28
The anti-inflammatory actions of glucocorticoids that INHIBIT something include:
Inhibit PLA2, decreased prostaglandin, interleukin, and cytokine production Inhibit cytokine production and secretion Inhibit fibroblast proliferation
29
The anti-inflammatory actions of glucocorticoids that SUPPRESS something include:
Suppression of lymphocyte activity and responsiveness | Suppress antigen presentation by macrophages and immunoglobulin production
30
The anti-inflammatory actions of glucocorticoids that DECREASE something include:
Decrease tissue histamine levels Decrease disposition of fibrogen and collagen Decrease capillary proliferation
31
Who has the most risk for glucocorticoid-induced osteoporosis?
children and postmenopausal women
32
In glucocorticoid-induced osteoporosis, there is a ____ in intestinal absorption and renal calcium reabsorption.
decrease
33
In glucocorticoid-induced osteoporosis, there is a ___ in parathyroid hormone secretion catabolizes bone.
increased
34
What is the effect on osteoblast and osteoclast activity in glucocorticoid-induced osteoporosis?
Osteoblast are inhibited | Osteoclast have an increased activity
35
What is known as excess glucocorticoids (either endogenous or exogenous)? and Whats a disease associated with it?
Hypercortisolemia Cushing Syndrome
36
What are the effects on plasma cortisol in Cushings? and what is a screening test you can do?
Decrease plasma cortisol Dexamethasone suppression test
37
When there is an adrenal adenoma such as a glucocorticoid producing tumor, this is known as?
primary
38
What is ACTH dependent from either a pituitary tumor, ecoptic ACTH production or ectopic CRF Production?
Secondary
39
Do you give a high or low dose of dexamethasone test?
High
40
If the plasma cortisol level decreases by greater than 50%, this is a positive or negative test?
Positive
41
If there is no cortisol suppression, decrease in plasma ACTH and increase in plasma ACTH, this is a positive or negative test?
Negative
42
Why would the Plasma ACTH Level increase/decrease in a negative Dexamethosone suppression test?
If the cause it an adrenal tumor, it will decrease. | If the cause is a ACTH secreting tumor, it will increase.
43
Other than a Dexamethasone test, what can be used to test for Hypercortisolemia?
Metyrapone test
44
The Metyrapone test assess what area in the pathology of hypercortisolemia?
Assessment of HPA axis function
45
The Dexamethasone suppression test assesses what area in the pathology of hypercortisolemia?
Site of dysfunction
46
What is an inhibitor of 11-beta-hydroxylase?
Metyrapone
47
If the plasma cortisol level decreases, increase in hypothalamic CRF, increase in plasma ACTH and 11-DOC, this is a positive or negative test?
Positive This indicates the HPA axis is responsive to a decrease in cortisol.
48
What does a negative metyrapone test indicate?
a lesion or alteration in the HPA axis
49
What is called a decrease in plasma cortisol from an adrenal insufficiency?
Hypocortisolemia
50
What is the most commonly the product of autoimmune polyendocrine deficiency syndrome?
Primary
51
Secondary Hypocortisolemia is caused by: (could be 2 things)
- Adrenal Suppression following exogenous glucocorticoids | - Following treatment for Cushings
52
If you give a patient ACTH and there is an INCREASE RESPONSE to ACTH, this is a ___ dysfunction
secondary
53
If you give a patient ACTH and there is an NO RESPONSE to ACTH, this is a ___ dysfunction
primary
54
If you give a patient CRH and there is an INCREASE RESPONSE to CRH, this is a ___ dysfunction
Hypothalamic
55
If you give a patient CRH and there is an NO RESPONSE to CRH, this is a ___ dysfunction
Pituitary
56
List the Glucocorticoid agonists in the short - medium half-life category which have high mineralocorticoid activity. (5)
``` Cortisol Cortisone Predinsone Prednisolone Methylprednisolone ```
57
List the Glucocorticoid agonist in the intermediate half-life category which have a minimal mineralocorticoid activity. (1)
Triamcinolone
58
List the Glucocorticoid agonist in the long half-life category which have a minimal mineralocorticoid activity and maximal anti-inflammatory property. (2)
Dexamethasone | Betamethasone
59
What is the MOST POTENT in anti-inflammatory activity when compared to cortisol?
Betamethasone
60
What is the LEAST POTENT in anti-inflammatory activity when compared to cortisol?
Cortisone
61
What drug has the GREATEST TOPICAL activity when compared to cortisol?
Betamethasone AND Dexamethasone
62
What drug has the GREATEST SALT-RETAINING activity when compared to cortisol?
Fludrocortisone
63
What drugs are in the form of injectable?
``` Coritsol Predinsolone Methylprednisolone Triamcinolone Betamethasone Dexamethasone ```
64
What drugs are in the form of topical?
Cortisol Triamcinolone Betamethasone Dexamethasone
65
Side effects of glucocorticoid therapy for high concentrations and extended durations (Just read these!)
``` Iatrogenic Cushing's syndrome Immune system suppression Osteoporosis Peptic Ulcers Growth suppression in children Alterations in CNS Function Reproductive problems Prolonged suppression of HPA axis ```
66
What are some strategies we can do to minimize the side effects of glucocorticoid therapy?
``` Short or intermediate acting drugs Pulse dosing Alternate day dosing Topical Administration Adjunct therapy with other anti-inflammatory drugs A combination of the above strategies ```
67
What are some effects of the alternate day dosing strategy?
Less HPA Axis suppression Less growth suppression Anti-Inflammatory properties outlast HPA/Growth suppression May not provide anti-inflammatory effects in some patients.
68
What is the prototype hormone secreted from the zona glomerulosa of the adrenal cortex and it's function?
Aldosterone (which is a mineralocorticoid) Promotes sodium reabsorption and potassium excretion
69
Where does Aldosterone bind in the nephron?
Distal and collecting tubules
70
List the 3 Mineralocorticoid agonists
Aldosterone Deoxycorticosterone Fludrocortisone
71
Name the endogenous mineralocorticoid agonist.
Aldosterone
72
What is the precursor of aldosterone?
Deoxycorticosterone
73
What mineralocorticoid agonist has glucocorticoid activity too?
Fludrocortisone
74
The most widely used mineralocorticoid is...
Fludrocortisone | In adrenocortical insufficiency associated with mineralocorticoid deficiency
75
Name the corticosteroid ANTAGONISTs that is a cytotoxic agent
Mitotane
76
Name the enzyme inhibitors that are corticosteroid ANTAGONISTS
Metyrapone Abiraterone Aminoglutethimide Ketoconazole
77
Name the receptor antagonists of corticosteroid ANTAGONISTS
Mifepristone Eplerenone Spironolactone
78
Which corticosteroid ANTAGONISTS decreases cortisol and sex steroid formation?
Abiraterone
79
What corticosteroid ANTAGONISTS is a aldosterone antagonists AND Its more selective than Spironolactone?
Eplerenone
80
T/F Spironolactone is an aldosterone antagonists?
True

Pharm II (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions