Exam I Flashcards
What are the three layers of the adrenal cortex and what do they secrete?
outermost to inner
- zona glomerulosa - mineralcorticoids (Aldosterone)
- zona fasiculata - glucocorcoids (cortisol)
- zona reticularis - sex steroids (P, E, T, DHEA)
This is the precursor of all steroid hormones..
progesterone
- produced in zona fasiculata
what is the name for cortisol when it’s used as a medication?
hydrocortisone
- can cause mild inc. in BP
What increases with glucocorticoids?
- glucose (gluconeogenesis, glycogenolysis)
- neutrophils
what decreases with glucocorticoids? leading to what significant SE of these medications?
- circulating lymphocytes
- decreased production of prostaglandins/leukotrienes
- decreased ability to fight off infection**
what are the two primary effects of glucocorticoid use?
- anti-inflammatory
- immunosuppressive (useful in organ transplant)
Compare steroid potencies of cortisone, hydrocortisone, prednisone, flumethasone, dexamethasone and betamethasone. Which are long (>48hr), intermediate (12-36), or short (<12) acting?
cortisone - 0.8, short hydrocortisone - 1.0, short prednisone - 4.0, intermed. flumethasone - 15.0, long dexamethasone -30, long betamethasone - 35, long
when considering topical steroids - which compounds are best for which skin types and what is a common SE of topical steroids?
dry - ointment, paste (50% pts)
oily - cream, lotion, drying gel
SE - skin thinning (increased with increase potency)
this, is a rapid decrease in the response to a drug over a relatively short time period - how is it avoided?
tachyphylaxis
- avoid by rx’ing use to one week on, one week off
what are the 6 mechanisms of tolerance?
- change in receptors
- loss of receptors
- exhaustion of mediators
- increased metabolic degradation
- physiological adaptation
- active extrusion of drug from cells
this product works as an effective vasoconstrictor - what is it? and what is it’s active ingredient?
Preparation H
- phenylephrine
when considering ocular glucocorticoids - what must be ruled out?
any infectious process
- ocular herpes esp, could cause complete corneal ulceration
this important drug class works by inhibiting phospholipase A2, blocking the release of arachadonic acid, which is the precursor to what?
glucocorticoids
- sones
inhibits
- prostaglandins
- leukotrienes
- suppresses histamine release and kinin activity
this drug class commonly causes SE of weight gain from salt and water retention, if used topically, it can cause skin atrophy - which drug class is this?
glucocorticoids
chronic glucocorticoid use can create redistribution of body fat, rounding of the face, appearance of striae, telangiectrasias, acne, and increase body hair growth - otherwise known as?
cushing-like appearance
This is generally due to glucocorticoid OVER-USE until proven otherwise, what is it?
bilateral avascular necrosis
cellular bone death due to interrupted blood supply
the stronger the corticosteroid effect, the ______ the mineral corticoid effect?
WEAKER
and visa versa
abrupt withdrawal of glucocorticoids can lead to (2)?
- ACUTE ADRENAL INSUFFICIENCY SYNDROME (ie - Addisonian crisis - LETHAL - fatigue, mm weakness, loss of appetite, weight loss, N/V, LOW BP*)
- exacerbation of the underlying disease
Hyperpigmentation can occur in what but not, what?
Hyperpigmentation occurs in:
PRIMARY Addison’s disease
NOT SECONDARY
- often in skin folds, mucus membranes
this drug is the preferred drug for cortisol replacement therapy, it works by affecting gene transcription either by up or down-regulating protein production - what is it and what’s it duration of action?
hydrocortisone
- short duration (8-12hrs)
this is the most used PO glucocorticoid in medicine and preferred in reactive airway diseases. it affects gene transcription by up or down-regulating protein production - it’s also important for leukemia reaction - what is it and what’s it’s DOA?
prednisone
- intermed. (12-36hrs)
- must be tapered*
this potent fluorinated corticosteroid is used IV for intracranial pressure reduction - affects gene transcription of proteins (up or down-reg), and it has minimal mineralcorticoid effect - drug and DOA?
dexamethasone
- long acting (>48hrs)
this corticosteroid is indicated for asthma maintenance, NOT ACUTE, it works by diminishing inflammation of the bronchial wall, what is it?
triamcinolone
- SE: thrush, sore throat, nosebleed, increased coughing, HA, runny nose
this pro-drug of corticosteroid is used for asthma prophylaxis, can be used to treat unusually severe aphthous ulcers
beclomethasone (QVAR)