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Endo II > Corticosteroids DSA > Flashcards

Corticosteroids DSA Flashcards

1
Q

aldosterone

A

mineralocorticoid

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2
Q

cortisol

A

glucocorticoid

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3
Q

CRH

A

corticotropin releasing hormone

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4
Q

ACTH

A

adrenicorticotropic hormone

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5
Q

dexamethasone

A

semisynthetic glucocorticoid

aka decadron

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6
Q

hydrocortisone

A

semisynthetic glucocorticoid

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7
Q

methylprednisolone

A

semisynthetic glucocorticoid

aka medrol

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8
Q

prednisolone

A

semisynthetic glucocorticoid

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9
Q

prednisone

A

semisynthetic glucocorticoid

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10
Q

fludrocortisone

A

mineralocorticoid

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11
Q

zona glomerulosa

A

ANG II receptor

synthesis of aldosterone

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12
Q

zona fasciculata and reticularis

A

17 alpha hydroxylase and 11-beta hydroxylase

regulated by ACTH

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13
Q

POMC

A

precursor protein

forms MSH, ACTH, LPH, and beta endorphin

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14
Q

ACTH MOA

A

GPCR activity

activates synthesis of corticosteroids

mobilization of cholesterol

also - trophic (growth) effect on adrenal cortical cells

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15
Q

diurnal ACTH

A

peak ACTH early in the morning

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16
Q

cortisol negative feedback

A

inhibit release of CRH from hypothalamus

inhibit release of ACTH from pituitary

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17
Q

therapeutic glucocorticoids

A

high doses for long time

-supress HPA axis

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18
Q

stress stimuli

A

injury, hemorrhage, infection, surgery, cold, pain, fear, etc.

can override normal negative feedback
-leading to elevated levels of adrenocortical steroids

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19
Q

cushings syndrome

A

hypercortisol

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20
Q

addisons disease

A

primary adrenocortical insufficiency

T cell mediated autoimmune destruction, infection, infiltration, cancer, b/l TB of adrenals, hemorrhage
-in adrenal cortex

decreased

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21
Q

secondary adrenocortical insufficiency

A

decreased circulating ACTH levels

adrenal atrophy and low levels of glucocorticoids

may be due to prolonged glucocorticoid tx**

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22
Q

ACTH plasma concentration measure

A

immunoradiometric assay

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23
Q

adrenal cortex steroids

A

corticosteroids - gluco and mineralo - 21 carbons

androgens - 19 carbons

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24
Q

type I GR

A

glucocorticoid receptor - GR

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25
type II GR
mineralocorticoid receptor - MR
26
steroid hormone receptor mechanisms
in cytoplasm of cells complexed with heat shock proteins -dissociate when bind steroid activated receptor - to nucleus and bind GREs** GRE site binding - either activates or inhibits transcription of specific genes
27
cortisol and aldosterone
both bind MR with equal affinity
28
mineralocorticoid specificity
tissue specific localization of receptor enzymatic protection against glucocorticoid excess -11-beta hydroxysteroid DH inactivates cortisol to cortisone differential binding of GR and MR to nuclear transcription factors
29
11-beta hydroxysteroid DH
inactivates cortisol to cortisone
30
effect of corticosteroids
decrease peripheral glucose uptake (anti-insulin) stimulate protein breakdown and lipolysis stimulate gluconeogenesis in liver net effect - elevated blood glucose** also - redistribution of body fat - moon facies and buffalo hump
31
aldosterone effect
enhance reabsorption of Na in kidney distal tubules and collecting ducts increased K and H secretion in urine
32
excess aldosterone
elevated Na expansion of ECF volume, hyponatremia, hyperkalemia, acidosis
33
glucocorticoids and immunosuppression
can prevent or suppress inflammation inhibit production and release of cytokines that normally stimulate proliferation and function of B and T cells glucocorticoids - suppress IFN, GM-CSF, ILs, TNF, prostaglandins, and leukotrienes
34
IL-1
inflammatory cytokine - stimulate release of CRH and ACTH - increase glucocorticoids - which in response inhibit immune/inflammatory response further
35
steroid absorption
lipophilic diffuse across cell membranes wide volume of distribution
36
steroid transport
90% cortisol bound to protein albumin and corticosteroid binding globulin (CBG
37
transcortin
CBG | -corticosteroid binding globulin
38
higher steroid levels
binding capacity of CBG and albumin is overwhelmed - much more free state and is more active
39
biological half life
used for steroid because plasma drug concentration does not correlate with time course of bio effects
40
anti-inflammatory effects
mediated by same receptor as metabolic effects -none of glucocorticoid derivatives have selective anti-inflammatory activity without also affecting carb, protein, fat metabolism
41
compounds that are classified as glucocorticoids
also have modest but significant mineralocorticoid activity
42
long acting glucocorticoids
betamethasone | dexamethasone
43
short acting glucocorticoids
cortisol and cortisone
44
intermediate acting glucocorticoids
prednisone prednisolone methylprednisolone triamcinolone
45
mineralocortoids
corticosterone fludrocortisone
46
beclomethasone dipropionate
inhalation for asthma or COPD
47
toxicity of adrenocortical steroids
1 - withdrawal effects | 2- continued use of high dose
48
withdrawal of adrenocorticosteroids
flare up of underlying disease acute adrenal insufficiency** consider this in any patient with high dose over 2 weeks
49
continued use of high dose corticosteroids
``` suppression of HPA axis HTN and hypoerglycemia increased infections peptic ulcers myopathy behavioral changes cataracts osteoporosis osteonecrosis growth retardation ```
50
unharmful steroid therapy
single dose or short course (1 week)
51
steroid therapy for life-threatening disease
initial dose should be large - aimed at achieving rapid control of crisis no benefit observed - dose doubled or tripled
52
steroid therapy regimens
alternate day - to diminish HPA suppression pulse therapy - for high dose glucocorticoids
53
glucocorticoid therapy
palliative | because underlying cause of disease remains
54
glucocorticoids inhibit
both early inflammatory processes and later manifestations
55
lipocortins
induced by glucocorticoids | -inhibit phospholipase A2 activity and suppress release of lipid mediators from cells
56
rheumatoid arthritis
main cytokine - TNF-alpha tx - glucocorticoids
57
osteoarthritis tx
intraarticular joint injections
58
ICS therapy
inhaled corticosteroids -for tx of bronchial asthma for prophylaxis
59
severe asthma attack tx
aggressive treatment with parenteral glucocorticoids IV methylprednisolone -followed by oral prednisone dose tapered gradually
60
tx allergic disease
immediate epinephrine tx glucocorticoids to suppress delayed inflammation
61
tx of ocular diseases
topical glucorticoids may exacerbate glaucoma - increased intraocular eye pressure may also mask ocular infection - CI in herpes simplex infections
62
CI for glucocorticoids in eye disease
herpes simplex infection mechanical laceration/abrasion - impaired wound healing
63
skin disease tx
topical glucocorticoids | -hydrocortisone 1%
64
tx of ulcerative colitis and crohns
oral prednisone and enteric coated budesonide
65
cerebral edema tx
corticoisteroids useful with parasites and neoplasms
66
mitotane
o,p - DDD -similar to insecticides selective toxicity for adrenal cortex used only to treat inoperable adrenal tumors
67
RU-486
progesterone receptor antagonist aka mifepristone use to terminate early pregnancy inoperable patients with ectopic ACTH secretion or adrenal cracinoma failed to respond to other tx options
68
spironolactone
K-sparing diuretic -competes for mineraolcorticoid receptor aldosterone antagonist effective tx for hyperaldosteronism

Endo II (12 decks)

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