Corticosteroids Flashcards
(50 cards)
1
Q
Mineralocorticoids are regulated by
A
- angiotensin II
- K+
2
Q
Glucocorticoids-cortisol is regulated by
A
- ACTH stimulates release
3
Q
effect of Glucocorticoids on carbs, protein, and fat
A
- increase circulating levels of glucose, free fatty acids and amino acids
- antagonizes insulin
- redistribution of body fat (extremities -> central)
4
Q
effect of Glucocorticoids on cardiovascular function
A
- increase vascular responsiveness to sympathetic stimulation
- inhibits catecholatmine reuptake
- some Na+ and H2O retention
- increase CO
5
Q
effect of Glucocorticoids on endocrine
- CRH
- GH
- TSH
- LH
- epi
A
- negative feedback on CRH -> Decrease ACTH
- decreases
- GH
- TSH
- LH -> inhibits reproduction
- increase Epinephrine production from adrenal medulla
6
Q
glucocorticoid effect on vitamin D and parathyroid
A
- vit D -> decreased Ca2+ deposition into bone
- increases parathyroid hormone -> increase Ca2+ loss from bone
7
Q
glucocorticoid effect on immune system
A
-
immunosuppressive
- decrease WBC #
-
blocks all steps in inflammation
- blocks heat, erythema, swelling, tenderness
- decreases PLA2, COX2, cytokines and IgE responses
- suppression of wound healing
8
Q
glucocorticoid effect on CNS
A
- mood elevation
- insomnia
- anxiety
- depression
- psychosis
9
Q
glucocorticoid effect on GI
A
associated with peptid ulcer development
10
Q
What is Cushings
A
- glucocorticoid excess
- cause
- ACTH excess - tumor
- cortisol excess
- tumor
- exogenous glucocorticoids
11
Q
List common signs of Cushings
A
- Buffalo hump
- thinning of skin
- thin arms and legs
- euphoria
- moon face with red cheeks
- increased abdominal fat
- easy bruising
- poor wound healing
12
Q
symptoms of Addison’s disease
A
- adrenocorticol insufficiency
- weight loss
- hyperpigmentation
- hypotension
- hypoglycemia, salt craving
13
Q
What is addisonian crisis
A
- acute adrenal insufficiency
- circulatory collapse, dehydration, vomiting, hyperkalemia
- fatal
14
Q
What is the one Mineralocorticoid medication
A
-
Fludrocortisone
- increase Na+/H2O retention
15
Q
two main uses for glucocroticoids medications
A
- replacement
- anti-inflammation
16
Q
Function of Hydrocortisone
A
- aka cortisol
- exhibits both mineralocorticoids and glucocorticoid properties equally
17
Q
indications for Hydrocortisone (Cortef)
A
- replacement therapy for adrenal insufficiency
18
Q
Function of Cortisone (Cortone)
A
- exhibits both mineralocorticoid and glucocorticoid properties equally
- cortisone must first be converted to hydrocortisone in liver in order to be active
19
Q
indications for Cortisone (Cortone)
A
replacement therapy for adrenal insufficiency
20
Q
List the three drugs used for replacement therapy
A
- Glucocorticoid:
- Hydrocortisone (Cortef® )
- Cortisone (Cortone®)
- Mineralocorticoid:
- Fludrocortisone (generic)
21
Q
List the Anti-inflammatory drugs
A
- Prednisone (Meticorten®)
- Prednisolone (Delta-Cortef®)
- Methylprednisolone (Medrol®)
- Triamcinolone (Aristocort®, Kenalog®)
- Betamethasone (Celestone®)
- Dexamethasone (Decadron®)
- Fluticasone (Flovent®, Flonase®)
22
Q
Differentiate between Prednisone and Prednisolone
A
prednisone must first be converted to prednisolone in the liver in order to be active
23
Q
effects of Prednisone and Prednisolone
A
more glucocorticoid effects than mineralocorticoid
24
Q
Effects of Triamcinolone, and Methylprednisolone Dexamethasone
A
- high glucorcorticoid activity
- virtually no mineralocorticoid activity
25
list education for patients taking topical glucocorticoids
* more potent topicals -\> thick skin only
* skin damage or thin skin -\> increases systemic absorption
* repeated application -\> depot effect
26
preparations of glucocorticoids
* oral: long term therapy
* injections
* inhalation
* topical
27
indications of Fludrocortisone
* Has both mineralocorticoid and glucocorticoid activity
* More significant mineralocorticoid effects: used as an aldosterone agonist
* Given with glucocorticoids in the treatment of adrenocortical insufficiency when more mineralocorticoid effects are needed.
28
How is patient with a chronic adrenal insufficiency (Addisons) treated
* tx with glucocorticoid alone or with a glucocorticoid + mineralocorticoid
29
dosage of replacement therapy in patient with a chronic adrenal insufficiency (Addisons) during times of stress or infection
* 2x for minor stress
* up to 10 x for major stress
30
Inhaled steroids have become first line treatment for
asthma
* used inconjunction with B2 agonist
31
Therapeutic guidelines for giving corticosteroids
* lowest effective dose
* use locally whenever possible
* give on alternate days
* decreasses suppression of HPA axis
32
chronic tx of corticosteroids can have what effect on HPA axis
* can cause suppression of HPA axis
* \*short term therapy (1-2 weeks) is not likely to cause serious problem
33
List the adverse effects of corticosteroid use
1. Infections
1. may mask symptoms
2. more susceptible to serious infection
2. hyperglycemia
1. may unmask diabetes
3. CNS
4. osteoporosis
5. Cushingoid effects
34
List the adverse effects of corticosteroid use on CNS
* restlessness, insomina, increase appetite
* seen even with acute treatments
35
abrupt cessation of corticosteroids tx can cause
* **acute adrenal insufficiency**
* do gradual withdrawal
36
patients who are chronically taking corticosteroids can get what during times of stress
stress can cause adrenal crisis
37
list the 4 main signs of Cushingoid effects
* acne
* truncal obestiy
* buffalo hump
* moon face
38
contraindications to taking corticosteroids in adrenal insufficiency
NONE
39
contraindications to taking corticosteroids
* infection
* diabetes
* osteoporosis
* heart disease or HTN
* immunosuppressed
* childhood
* pregnancy
40
list the things to monitor when patient is on corticosteroids
* hyperglycemia
* Na+ retension with edema or HTN
* hypokalemia
* peptid ulcer
* osteoporosis
* infections
* growth and development in children
41
all agents that inhibit corticosteroids can precipitate what
acute adrenal insufficiency
42
List the corticosteroid synthesis inhibitors
* Aminoglutethimide
* Ketoconazole
43
MOA of Aminoglutethimide
* blocks **adrenal and gonadal** steroid synthesis
44
Aminoglutethimide must be given with what to suppress ACTH
corticosteroids
45
MOA of Ketoconazole
* antifungal that inhibits steroid synthesis at high doses
* **non-selective**
46
List the glucocorticoid receptor antagonist
* Mifepristone
47
MOA of Mifepristone
* antagonist of glucocorticoid and progesterone receptors
48
use of Mifepristone
for inoperable cushings patients
49
MOA of spironolactone
* Mineralocorticoid (and some androgen) receptor antagonist
* potassium sparing
50
use of spironolactone
* hyperaldosteronism
* hirsutism
