Corticosteroids

Question 1

What drug/ hormone is a mineralocorticoid?

Answer 1

Aldosterone

Question 2

What drug/ hormone is a glucocorticoid?

Answer 2

Cortisol

Question 3

What is aldosterone regulated by?

Answer 3

ATII and K+

Question 4

What is cortisol regulated by?

Answer 4

ACTH

Question 5

What are the 2 main effects of aldosterone?

Answer 5

↑ Na+ and H2O retention and ↑ K+ excretion

Question 6

What does cortisol exert a negative feedback effect on?

Answer 6

CRH = ↓ ACTH

Question 7

Is cortisol a short or long acting stress hormone?

Answer 7

Long acting (acts via nuclear receptors)

Question 8

Does cortisol favor catabolic or anabolic processes?

Answer 8

Catabolic (favors energy release) (↑ circulating glucose, FFA, AA)

Question 9

Cortisol antagonizes the effects of what hormone?

Answer 9

Insulin

Question 10

How does cortisol play a role in fat redistribution?

Answer 10

Redistribution of fat centrally

Question 11

What are the CV effects of cortisol (2)

Answer 11

↑ vascular responsiveness to sympathetic stimulation b/c inhibition of catecholamine re-uptake (more catecholamines in cleft = more effects), ↑ CO

Question 12

Cortisol has endocrine effects by decreasing what hormones?

Answer 12

GH, TSH, LH

Question 13

Cortisol has endocrine effects by increasing what hormone?

Answer 13

Epi

Question 14

How does cortisol lead to bone destruction over time? (2)

Answer 14

Inhibits action of vit. D → ↓ Ca deposition ↑ PTH → ↑ Ca loss from bone

Question 15

What are the effects of cortisol on the immune system?

Answer 15

Immunosuppressive, anti-inflammatory, suppression of wound healing (early and late stages)

Question 16

What effects can cortisol have on the CNS, although there is individual variance? (5)

Answer 16

Mood elevation, insomnia/ restlessness, anxiety, depression, psychosis

Question 17

What is the possible GI related SE of cortisol?

Answer 17

Peptic ulcer development

Question 18

Is Cushing’s glucocorticoid excess or insufficiency?

Answer 18

Excess

Question 19

What is the cause of Cushing’s disease?

Answer 19

Excess ACTH due to tumor in the pituitary gland

Question 20

What is the cause of Cushing’s syndrome?

Answer 20

Excess cortisol due to anything else besides ACTH secreting pituitary tumor

Question 21

What is the most common cause of Cushing’s syndrome?

Answer 21

Exogenous glucocorticoids (could also be a tumor)

Question 22

What are the following sxs associated with?

Buffalo hump, thinning of skin, thin arms, moon face, increased abdominal fat, striae, easy bruising, poor wound healing

Answer 22

Cushing’s

Question 23

What test is performed for the diagnosis of Cushing’s after a low dose dexamethasone suppression test?

Answer 23

High dose dexamethasone suppression test

Question 24

For the high dose dexamethasone suppression test, you measure baseline cortisol levels in AM, administer dexamethasone in the PM, then measure levels again when?

Answer 24

The following morning (when it should be the highest due to circadian release)

Question 25

On the high dose dexamethasone suppression test, extreme suppression of cortisol indicates what?

Answer 25

Normal

Question 26

On the high dose dexamethasone suppression test, cortisol levels 50% suppressed indicate what?

Answer 26

Cushing's disease

Question 27

On the high dose dexamethasone suppression test, unchanged cortisol levels indicate what?

Answer 27

Cushing's syndrome

Question 28

Addison's disease, adrenal malfunction, and pituitary malfunction lead to adrenocortical excess or insufficiency?

Answer 28

Insufficiency

Question 29

What are the sxs of adrenocortical insufficiency? (4)

Answer 29

Hyperpigmentation, salt craving, anorexia, weight loss

Question 30

Acute adrenal insufficiency is aka?

Answer 30

Addisonian crisis

Question 31

Circulatory collapse, dehydration, vomiting, hyperkalemia, and the possibility of these sxs to be fatal is what condition?

Answer 31

Addisonian crisis

Question 32

Condition in which the body is unable to repond to acute high stress so need exogenous mineralocorticoid to appropriately respond to stress is what?

Answer 32

Addisonian crisis

Question 33

Ketoconazole drug class?

Answer 33

Corticosteroid synthesis inhibitor

Question 34

Mifipristone drug class? (corticosteroids)

Answer 34

Receptor antagonists

Question 35

Spironolactone drug class (corticosteroids)

Answer 35

Receptor antagonists

Question 36

What is the relative mineralocorticoid (salt-retaining) and glucocorticoid (anti-inflammatory) activity of hydrocortisone and cortisone?

Answer 36

Equal activity

Question 37

What is the relative mineralocorticoid (salt-retaining) and glucocorticoid (anti-inflammatory) activity of prednisone and prednisolone?

Answer 37

Glucocorticoid \> mineralocorticoid

Question 38

What is the relative mineralocorticoid (salt-retaining) and glucocorticoid (anti-inflammatory) activity of methylprednisolone and triamcinolone?

Answer 38

Virtually no mineralocorticoid activity

Question 39

Is hydrocortisone or cortisone inactive?

Answer 39

Cortisone inactive, 80% potency

Question 40

Is prednisone or prednisolone inactive?

Answer 40

Prednisone

Question 41

What is the primary use of hydrocortisone and cortisone?

Answer 41

Replacement therapy for adrenal insufficiency

Question 42

What is the duration of hydrocortisone and cortisone?

Answer 42

Short duration (8-12 hours)

Question 43

What is the primary use of prednisone and prednisolone?

Answer 43

Anti-inflammatory effects (with minor salt-retaining effects)

Question 44

What is the duration of prednisone and prednisolone?

Answer 44

Intermediate duration (12-36 hours)

Question 45

What is the use of methylprednisone and triamcinolone?

Answer 45

Anti-inflammatory (with no salt-retaining effects)

Question 46

What is the duration of methylprednisone and triamcinolone?

Answer 46

Intermediate duration (12-36 hours)

Question 47

What is the use of dexamethasone and betamethasone?

Answer 47

Anti-inflammatory (with no salt-retaining effects)

Question 48

What is the duration of dexamethasone and betamethasone?

Answer 48

Long duration (36-72 hours)

Question 49

What is the use of fluticasone?

Answer 49

Most commonly prescribed inhaled mineralocorticoid

Question 50

What is the use of aldosterone?

Answer 50

Salt-retaining with minimal anti-inflammatory effects

Question 51

What is the use of fludrocortisone?

Answer 51

Salt retaining with minimal anti-inflammatory effects

Question 52

What is the use of oral corticosteroids?

Answer 52

High dose/ long-term therapy or replacement therapy

Question 53

What is the use of corticosteroid injections?

Answer 53

Emergencies or depot administration

Question 54

What is the use of inhalation/ intranasal corticosteroids?

Answer 54

Asthma and rhinitis

Question 55

What are the 3 notable properties/ effects of topical corticosteroids?

Answer 55

Insoluble (prevents absorption), more potent used on thick skin only (if skin damage/ thin skin → systemic absorption), repeated application = depot effect

Question 56

What is the danger about acute adrenal insufficiency?

Answer 56

Can be life threatening

Question 57

When will you see increased amounts of corticosteroids?

Answer 57

Stress or infection

Question 58

What is the DOC for initial treatment of asthma?

Answer 58

Inhaled glucocorticoid

Question 59

Why are corticosteroids used in the treatment of RA?

Answer 59

Decrease inflammation (used in inflammatory conditions in general)

Question 60

What therapeutic guideline should be followed for corticosteroid treatment with respect for amount of time and dose given?

Answer 60

Only as long as necessary at lowest effective dose

Question 61

Should you start corticosteroid treatment at a high or low dose?

Answer 61

Start at higher dose, taper down once inflammation is under control

Question 62

Should corticosteroids be used locally or diffuse?

Answer 62

Locally whenever possible

Question 63

Should corticosteroids be given daily or an alternate days?

Answer 63

Alternate days

Question 64

When are corticosteroids most likely to cause adverse effects and result in suppressed HPA (for months)?

Answer 64

Chronic or high dose (short term therapy (1-2 weeks) is not likely to cause serious problems)

Question 65

What is the worst adverse effect of corticosteroid treatment that limits therapeutic effects?

Answer 65

Osteoporosis

Question 66

How does corticosteroid treatment affect infection?

Answer 66

Masks sxs of infection/ makes more susceptible to infection (this can lead to serious infection)

Question 67

How can corticosteroid treatment after diabetes pts?

Answer 67

Hyperglycemia (may "unmask" DM in some pts)

Question 68

What are some of the adverse CNS effects seen with corticosteroid treatment? (seen with acute or chronic txs)

Answer 68

Restlessness, insomnia, psychosis, increased appetite

Question 69

Why should you avoid abrupt cessation or more than 1-2 weeks of high dose therapy with corticosteroids? (2)

Answer 69

Induce adrenal insufficiency/ HPA depression Can cause cushingoid SEs

Question 70

How can corticosteroid treatment affect chronic pts?

Answer 70

Stress intolerance

Question 71

When are there no contraindications to corticosteroid treatment?

Answer 71

Adrenal insufficiency

Question 72

The following are contraindications to what? Systemic bacterial or viral infection, poorly controlled DM, osteoporosis, heart disease or HTN w/ CHF, IMC, pregnancy, childhood

Answer 72

Corticosteroid treatment with NO adrenal insufficiency

Question 73

What is the MOA of ketoconazole besides antifungal?

Answer 73

Inhibits steroidogenesis (cortisol) production at high doses

Question 74

What is the DOC in pre-surgical Cushing's pts?

Answer 74

Ketoconazole

Question 75

What are the SEs of ketoconazole? (4)

Answer 75

Reversible hepatotoxicity, gynecomastia, libido decrease, impotence

Question 76

What is the contraindication to ketoconazole?

Answer 76

Pregnancy

Question 77

What are the basic MOAs for spironolactone besdies potassium sparing diuretic? (as corticosteroid)

Answer 77

Mineralocorticoid, anti-androgen

Question 78

What are the uses for spironolactone (corticosteroids)? (2)

Answer 78

Hyperaldosteronism, hisutism