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Pharmacology 2 > Corticosteroids > Flashcards

Corticosteroids Flashcards

1
Q

What is the HPA axis

A

Stands for hypothalamic, pituitary, adrenal feedback mechanism

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2
Q

What does the cortex of the adrenal gland secrete

A
  1. Adrenocorticosteroids

2. Adrenal androgens

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3
Q

What are the 2 adrenocorticosteroids

A
  1. Glucocorticoids

2. Mineralcorticoids

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4
Q

What does the outer zone of the cortex secrete (zone glomerulosa)

A

Aldosterone (mineral corticoid)

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5
Q

Zona fasciculata secretes

A

Glucocorticoids (Cortisol)

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6
Q

Mineralocorticoids are responsible for what

A

Regulating salt and water metabolism

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7
Q

Glucocorticoids are responsible for what

A
  1. Dramatically reduces the inflammatory response (inhibition of phospholipase A)
  2. Suppress immunity
  3. Help resist stress
  4. Maintain normal metabolism
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8
Q

How does the HPA work

A

Hypothalamus releases corticotropin releasing hormone (CRH), which stimulates pituitary to release and ACTH, which stimulates the adrenals, causing the release of cortisol or aldosterone

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9
Q

Why do you give a morning dose of corticosteroids

A

Because normal body cortisol starts to peak at 6-8am and ACTH peaks at midnight to 2AM. Which allows the drug to work synergistically with the body’s natural corticosteroid release

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10
Q

What are the two inner zones controlled by

A

The pituitary adrenocorticotropic hormone (ACTH)

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11
Q

What stimulates the release of ACTH

A

The hypothalamus releases hypothalamic corticotropin releasing hormone (CRH)

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12
Q

What are feedback INHIBITORS of corticotropin(ACTH) and CRH

A

Glucocorticoids (cortisol)

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13
Q

What happens if you have low glucocorticoid

A

You can get hypoglycemia (may occur during stress or fasting)

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14
Q

Glucocorticoids promote the making of what

A

glucose (glucogenesis). So if you have low glucocorticoids you may have low levels of glucose

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15
Q

Glucocorticoid actions

A
  1. Decrease inflammatory response
  2. Promote glucogenesis
  3. Increases neutrophils
  4. Decreases lymphocytes, eosinophils
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16
Q

How does glucocorticoid decrease the inflammatory response

A

By inhibiting phospholipase A, which decreases the production of arachidonic acid (prostoglandins/leukotrienes)

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17
Q

What are the 2 arachidonic acids

A

Lipooxygenase (leukotrienes) and Cyclooxygenase (prostaglandins)

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18
Q

What are marginated neutrophils

A

Neutrophils that are going to be activated during an infection and will travel out to interstitium (neutrophil count goes up)

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19
Q

What are demarginated neutrophils

A

Neutrophils that do not get activated during an infection (still in bloodstream)

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20
Q

What happens to the neutrophil concentration in the bloodstream during demargination

A

The neutrophil count in the blood will be significantly higher because the neutrophils did not get activated and sent out into the interstitial tissues

21
Q

What causes demargination

A

Glucocorticoids (corticosteroids) - —this is one of the ways that steroids help keep inflammation down

22
Q

What part of the nephron does aldosterone work at

A

The Collecting ducts

23
Q

What does aldosterone do at the collecting ducts

A

Causes reabsorption of Na+ and water (HCO3 too)

24
Q

What affect does aldosterone have on K+

A

It decreases the reabsorption of K+, so it is therefore lost in the urine

25
Q

What is cushing syndrome caused by

A

Hypersecretion of glucocorticoids due to excessive release of corticotropin (pituitary) or an adrenal tumor

26
Q

Clinical uses of corticosteroids

A
  1. Allergic rhinitis and asthma
  2. Arthritis
  3. Autoimmune disorders
  4. Brain and spinal cord tumors
  5. Replacement therapy for adrenocortical insufficiency (addison)
27
Q

What are leukotrienes involved in

A

Inflammation and bronchospasm

28
Q

What are prostaglandins involved in

A
  1. Vasodilation
  2. Bronchodilation
  3. Platelet aggregation
  4. Some vasoconstriction (decreases edema, fever)
  5. Pathogenesis of pain
29
Q

What is the difference among commonly prescribed steroids

A

The potency and the amount in mg of the drug

30
Q

Which drug is the least potent

A

Cortisol

31
Q

Which drug is the most potent

A

Dexamethasone

32
Q

Common corticosteroids

A
  1. Cortisol
  2. Prenisone
  3. Methlyprednisolone
  4. Dexamethasone
  5. Hydrocortisone (identical to natural cortisol)
33
Q

What is the difference in mg and potency between prednisone and methylprednisolone

A 
P = 5mg
MP = 4mg
P= 3.5 potency (x more potent than cortisol)
MP = 5 potency
34
Q

What is prednisolone

A

The activated form of prednisone (occurs via metabolism in the body)

35
Q

What type of patient is prednisone preferred in

A

Pregnant women (because the prednisolone derivative does not go to the fetus)

36
Q

Where are corticosteroids metabolized

A

Liver, then excreted by the kidneys

37
Q

How much of the glucocorticoids are bound by plasma protein during absorption

A

90%

38
Q

What can happen if a patient is on steroids for too long

A

Suppression of the HPA axis, so alternate day dosing may be needed

39
Q

Which drug would you give to an Addison patient

A

Hydrocortisone of prednisone in order to mimic the natural cortisol that is missing in these patients

40
Q

Short term adverse effects

A
  1. Dose dependent
  2. Hyperglycemia (diabetic)
  3. GI bleeding
  4. Na+ retention
  5. Hypokalemia
  6. Emotional disturbances
41
Q

Long term adverse effects

A
  1. Continuation of short term effects
  2. HPA axis suppression after 2 weeks
  3. Muscle weakness
  4. Thinning of skin, bruising
  5. Osteoporosis
  6. Cataracts/glaucoma
  7. Increased risk of infection
  8. Body fat distributed around waist (cushingnoid)
42
Q

What is the most common long term effect

A

Osteoporosis

43
Q

physiological dose

A

Doses of steroid that are made by the adrenal gland under normal conditions

44
Q

Why do you have to taper long term steroids

A

It can cause acute adrenal insufficiency (especially in pts who have already had HPA suppression)

45
Q

How many months does it take to fully restore HPA in a patient taking steroids for more than 30 days

A

9-12 months after slow withdrawal and complete removal

46
Q

When can you taper rapidly

A

In patients who received steroids for less than 14 days

47
Q

What drug blocks the effects of prostaglandins

A

NSAIDS and the indirect actions of glucocorticoids

48
Q

How do you taper with short-term high dose

A

Rapid taper from high dose is ok, but don’t go below the chronic dose

Pharmacology 2 (8 decks)

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