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Pharmacology 2 > Corticosteroids > Flashcards

Corticosteroids Flashcards

(48 cards)

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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

Study These Flashcards
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

Study These Flashcards
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

Study These Flashcards
A

The Collecting ducts

23
Q

What does aldosterone do at the collecting ducts

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A

Causes reabsorption of Na+ and water (HCO3 too)

24
Q

What affect does aldosterone have on K+

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A

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

25
What is cushing syndrome caused by
Hypersecretion of glucocorticoids due to excessive release of corticotropin (pituitary) or an adrenal tumor
26
Clinical uses of corticosteroids
1. Allergic rhinitis and asthma 2. Arthritis 3. Autoimmune disorders 4. Brain and spinal cord tumors 5. Replacement therapy for adrenocortical insufficiency (addison)
27
What are leukotrienes involved in
Inflammation and bronchospasm
28
What are prostaglandins involved in
1. Vasodilation 2. Bronchodilation 3. Platelet aggregation 4. Some vasoconstriction (decreases edema, fever) 5. Pathogenesis of pain
29
What is the difference among commonly prescribed steroids
The potency and the amount in mg of the drug
30
Which drug is the least potent
Cortisol
31
Which drug is the most potent
Dexamethasone
32
Common corticosteroids
1. Cortisol 2. Prenisone 3. Methlyprednisolone 4. Dexamethasone 5. Hydrocortisone (identical to natural cortisol)
33
What is the difference in mg and potency between prednisone and methylprednisolone
``` P = 5mg MP = 4mg P= 3.5 potency (x more potent than cortisol) MP = 5 potency ```
34
What is prednisolone
The activated form of prednisone (occurs via metabolism in the body)
35
What type of patient is prednisone preferred in
Pregnant women (because the prednisolone derivative does not go to the fetus)
36
Where are corticosteroids metabolized
Liver, then excreted by the kidneys
37
How much of the glucocorticoids are bound by plasma protein during absorption
90%
38
What can happen if a patient is on steroids for too long
Suppression of the HPA axis, so alternate day dosing may be needed
39
Which drug would you give to an Addison patient
Hydrocortisone of prednisone in order to mimic the natural cortisol that is missing in these patients
40
Short term adverse effects
1. Dose dependent 2. Hyperglycemia (diabetic) 3. GI bleeding 4. Na+ retention 5. Hypokalemia 6. Emotional disturbances
41
Long term adverse effects
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
What is the most common long term effect
Osteoporosis
43
physiological dose
Doses of steroid that are made by the adrenal gland under normal conditions
44
Why do you have to taper long term steroids
It can cause acute adrenal insufficiency (especially in pts who have already had HPA suppression)
45
How many months does it take to fully restore HPA in a patient taking steroids for more than 30 days
9-12 months after slow withdrawal and complete removal
46
When can you taper rapidly
In patients who received steroids for less than 14 days
47
What drug blocks the effects of prostaglandins
NSAIDS and the indirect actions of glucocorticoids
48
How do you taper with short-term high dose
Rapid taper from high dose is ok, but don't go below the chronic dose

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