Corticosteroids

Question 1

When are ACTH and cortisol mostly secreted

Answer 1

morning when you wake up

Question 2

bind to cytoplasmic receptor

Answer 2

Corticosteroids

Question 3

acts as transcription factor, regulates the transcription leading to mRNA and protein synthesis

Answer 3

GRE - glucocorticoid response elements

Question 4

4 things to remember about corticosteroids

Answer 4

1) give in the morning
2) give as single dose in morning
3) takes 14 days to work
4) make sure to taper and takes 1 month for adrenals to recover

Question 5

1) reduced synthesis of COX2 and cytokines
2) inhibit fxn of macrophage and antigen presenting cells
3) increase lymphocyte apoptosis
4) inhibit neutrophil migration to tissue
5) inhibit phospholipase A2
6) decrease capillary permeability

Answer 5

physiological effects of glucocorticoids

Question 6

1) stimulate glycogen deposition in liver
2) gluconeogenesis
3) decrease peripheral utilization of glucose

Results = hyperglycemia and decreased insulin sensitivity

Answer 6

carbohydrate metabolism effects of glucocorticoids

Question 7

1) redistribution of body fat

2) moon face, buffalo hump, fish mouth, thin limbs, lemon on stick appearance

Answer 7

lipid metabolism effects of glucocorticoids

Question 8

protein breakdown
muscle wasting
tanning of skin
healing delayed

Answer 8

protein metabolism effect of glucocorticoids

Question 9

sodium and water retention

edema and hypertension on prolonged use

Answer 9

electrolyte and water effects of corticosteroids

Question 10

decrease calcium levels in blood by inhibiting calcium absorption from gut and increasing its renal excretion

prolong use causes osteoporosis

Answer 10

calcium effects of corticosteroids

Question 11

responsible for HTN associated with cushings

Answer 11

cortisols mineralocorticoids

Question 12

hypertension and worsening of congestive symptoms of heart failure due to sodium and water retention

Answer 12

CVS effects of corticosteroids

Question 13

inhibit prostaglandin synthesis, increased gastric acid synthesis
CI in peptic ulcer

Answer 13

GIT effects of corticosteroids

Question 14

hyperpigmentation, ACTH increase, hypotension, hyperkalemia, increase blood eosinophils count and fasting hypoglycemia

Answer 14

Addison’s dz

Question 15

treatment for Addisons

Answer 15

Hydrocortisone + fludrocortisone

Question 16

female newborn with ambiguous external genitalia
dehydration
hypotension

Answer 16

21 beta hydroxylase def

Question 17

treatment for 21 beta hydroxylase def

Answer 17

fludrocortisone + cortisol

Question 18

dexamethasone test results

1) blood cortisol suppression >50% means inhibition

Answer 18

pituitary cushings syndrome

Question 19

dexamethasone test results

1) blood cortisol suppression < 50% means no inhibition
2) ACTH increase

Answer 19

lung cancer

Question 20

dexamethasone test results

1) blood cortisol suppression < 50% means no inhibition
2) ACTH decrease

Answer 20

adrenal tumor

Question 21

short acting glucocorticoids

t half less than 12 hrs

Answer 21

hydrocortisone

prednisolone

Question 22

used in emergency

equal glucose and mineral corticoid activity

Answer 22

Hydrocortisone

Question 23

active drug
4x more potent
single dose in morning mimics normal circadian rhythm of cortisol

Answer 23

prednisolone

Question 24

intermediate acting

t half 12-36 hrs

Answer 24

triamcinolone

Question 25

no mineralocorticoid activity | no salt retaining

Answer 25

triamcinolone

Question 26

long acting | t half 36 hrs

Answer 26

dexamethasone

Question 27

no mineralocorticoid activity never given as replacement used in hospital only not used long term

Answer 27

dexamethasone

Question 28

inhalation steroid preparations

Answer 28

fluticasone beclomethasone budesonide triamcinolone

Question 29

topical steroid preparations

Answer 29

betamethasone triamcinolone hydrocortisone

Question 30

Cushing features

Answer 30

``` cataract ulcer skin thinner hypertension/hirsutism infection necrosis of femoral head glycosuria osteoporosis/obesity immunosuppression diabetes ```

Question 31

CI for glucocorticoids

Answer 31

``` peptic ulcer heart dz HTN with heart failure varicella TB psychosis diabetes osteoporosis glaucoma ```

Question 32

adrenal suppression Osteoporosis femur head avascular osteonecrosis muscle wasting

Answer 32

some ADR of glucocorticoids

Question 33

Uses for glucocorticoids

Answer 33

1) adrenal insufficiency 2) congenital adrenal hyperplasia 3) asthma 4) collagen vascular 5) ocular dz 6) lung maturation 7) skin dz 8) chemotherapy 9) cushings 10) cerebral edema 11) anti inflammatory

Question 34

abrupt stoppage of glucocorticoids therapy after prolonged use causing: 1) flaring up of underlying dz 2) with drawl sx - fever, myalgia, malaise, athralgia 3) acute adrenal insufficiency low dose should be used and tapered slowly without abrupt stopping to avoid ADR

Answer 34

HPA axis suppression

Question 35

Inhibits CYP450 (desmolase), which catalyze rate limiting step conversion of cholesterol to pregnenolone

Answer 35

Aminoglutethimide

Question 36

Reduces biosynthesis of all physiological steroids Used to decrease hypersecretion of cortisol in px with Cushing’s syndrome Used to reduce estrogen production in tx with great cancer with dexamethasone

Answer 36

Aminoglutethimide

Question 37

Inhibits CYP450 11 hydroxylase enzymes

Answer 37

Metyrapone

Question 38

Used to test adrenal fxn (insufficiency) - if pit and adrenal are normal will cause increase ACTH and atrophy of adrenal cortex - tumor suppresses ACTH and atrophy of adrenal cortex (not caused by adrenal tumor) Only adrenocorticoid antagonist that can be used for cushings in pregnacy

Answer 38

Metyrapone

Question 39

Antifungal Inhibits steroid synthesis in high doses except 21 hydroxylase Treatment for Cushing’s syndrome

Answer 39

Ketoconazole

Question 40

Antiprogestin activity High doses block glucocorticoid receptors Mainly used as contraceptive, abortificient (+ misoprostol)

Answer 40

Mifepristone

Question 41

Major minerocorticoid Secretion controlled by aldosterone and RAAS (increase BP) Acts on renal tubule cells to increase reabsorption of Na, bicarb, H2O in exchange for K excretion

Answer 41

Aldosterone

Question 42

Primarily used for replacement therapy after adrenalectomy or for primary and secondary adrenocortical insufficiency

Answer 42

Fludrocortisone

Question 43

ADR: hypokalemia and congestive heart failure due to volume overload

Answer 43

Fludrocortisone

Question 44

Aldosterone receptor antagonist - inhibits 17 alpha hydroxylase (competes with DHT) Treats: primary hyperaldosteronism and baldness in men due to excessive androgen

Answer 44

Spironolactone