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Basic Pharmacology > Glucocorticoids and Mineralocorticoids > Flashcards

Glucocorticoids and Mineralocorticoids Flashcards

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1
Q

what are some of the sex steroids?

A

estrogens
progesterone
testosterone

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2
Q

what do anabolic steroids promote?

A

protein synthesis and hence muscle mass
marginal success in stimulating bone marrow in anemic animals

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3
Q

do synthesized anabolic steroids used in medicine have reproductive side effects?

A

yes- fewer than testosterone

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4
Q

what are corticosteroids?

A

name implies steroids derived from adrenal cortex
mineralocorticoids and glucocorticoids

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5
Q

what are the two main steroid groups derived from the cortex?

A

mineralocorticoids: aldosterone
glucocorticoids: cortisol

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6
Q

when is cortisol released?

A

response to stress and low blood glucocorticoid levels

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7
Q

what are the functions of cortisol?

A

increase blood sugar through gluconeogenesis
suppress immune system
aid in fat, carbohydrate, and protein metabolism
reduce bone formation

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8
Q

what does an excess of cortisol lead to?

A

Cushing’s disease

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9
Q

what does a deficiency of cortisol lead to?

A

Addison’s disease

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10
Q

where does aldosterone act?

A

acts on distal tubules and collecting ducts of the nephron to resorb sodium and excrete potassium

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11
Q

what is the net effect of aldosterone?

A

increased water retention and blood pressure

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12
Q

what are two drugs that are intended for use as mineralocorticoids?

A

fludrocortisone
desoxycorticosterone pivalate

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13
Q

what drugs have pure glucocorticoid effects?

A

dexamethasone
betamethasone
flumethasone

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14
Q

what drugs have incidental or additive mineralocorticoid effects?

A

prednisolone
predef 2X (isoflupredone)

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15
Q

how do you convert a predisone dose to dexamethasone dose?

A

divide your pred dose by 7

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16
Q

the potency factor of pred is _____ times cortisol and dex is _____ times

A

4
30

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17
Q

what is the biological half-life of predisolone?

A

12-36 hours (intermediate)

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18
Q

what is the biological half-life of dexamethasone?

A

26-54 hours (long)

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19
Q

what describes IV drugs?

A

water soluble
can be given IV
duration controlled by biological half-life

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20
Q

what describes IM drugs?

A

water insoluble
given IM
duration controlled by rate of absorption (usually lasts 2-4 weeks)

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21
Q

what are the expected side effects of glucocorticoids?

A

PU/PD/PP (polyphasia)
panting
alopecia/hair thinning
increased ALP and vacuolar hepatopathy

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22
Q

what are unusual (important) adverse effects of glucocorticoids?

A

inhibit wound healing
increased susceptibility to infection
diabetes
laminitis in horses
GI ulceration
may cause abortion

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23
Q

in which species do we expect ALP to increase with glucocorticoids?

A

dogs
not cats

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24
Q

what is budesonide?

A

glucocorticoid

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25
what does budesonide do?
dissolves in duodenum to provide local anti-inflammatory activity suppresses HPA axis
26
what is oral budesonide good for orally?
gastrointestinal and potentially hepatic disease
27
what is fluticasone?
inhaled glucocorticoid in dogs and cats
28
what is important to think about with dosing cats on glucocorticoids?
much more resistant to side effects require 2x dose as dog for same anti-inflammatory effect dose not absorb predisone well (use prednisolone)
29
what is important to think about with horses on glucocorticoids?
does not absorb predisone well (use prednisolone) certain steroids are more prone to predispose to laminitis
30
what is important to think about with cattle on glucocorticoids?
prone to abortion/induction of parturition from certain steroids in last half of gestation and especially in last month of gestation
31
what is desoxycorticosterone pivalate?
pure mineralocorticoid
32
how do you dose desoxycorticosterone pivalate?
pivalate repository formulation allows dosing every 21-30 days
33
what is desoxycorticosterone pivalate used to treat?
hypoadrenocorticism
34
what is fludrocortisone acetate (Florinef) used for?
oral mineralocorticoid as alternative to DOCP also glucocorticoid action: PU/PD hypoadrenocorticism
35
what are the adverse effects of mineralocorticoids?
few PU/PD hypertension hypokalemia DOCP, rare: anemia, anaphylaxis, injection site reaction
36
what happens in Addison's disease?
adrenals do not produce enough of their intended steroid products: glucocorticoids, mineralocorticoids often both, sometimes isolated
37
what do we supplement with Addison's disease?
mineralocorticoids glucocorticoids
38
what does mineralocorticoid supplementation replace?
aldosterone
39
what does glucocorticoid supplementation mimic?
cortisol
40
what can be given during initial stabilization of Addison's disease that does not react with the cortisol assay?
dexamethasone
41
what drug is preferred for glucocorticoid supplementation?
prednisolone
42
what is the dosing range for prednisolone for Addison's?
0.1-0.4 mg/kg taper to no signs PU/PD/PP
43
how are mineralocorticoid dosages adjusted for an addisonian?
based on serum Na and K
44
what are glucocorticoid dosage adjustments based on in an addisonian?
clinical signs
45
do you ever need to change the glucocorticoid dose for an Addison's disease animal after finding a good dose?
yes: more glucocorticoids during times of stress 2-3x maintenance dose
46
how do glucocorticoids have an anti-inflammatory effect?
increase production of inhibitory protein lipocortin which inhibits phospholipase A2 within arachidonic acid cascade reduces inflammatory gene transcription reduces macrophage phagocytosis inhibits complement
47
how do you dose dogs for anti-inflammatory therapy using glucocorticoids?
begin at 1 mg/kg/day, taper down until signs controlled 0.5-1 mg/kg pred usually
48
what dose of prednisolone do cats usually need to accomplish anti-inflammatory therapy?
1-2 mg/kg
49
what is immunosuppressive dosing used for?
used to treat most immune-mediated diseases
50
when treating for immunosuppression, how do you dose a dog and a cat?
begin 2 mg/kg/day pred and taper over weeks to months cats 2-4 mg/kg prednisolone may be needed to accomplish same thing
51
why must a steroid be reduced gradually after being used for longer than a couple of weeks?
to avoid iatrogenic hypoadrenocorticism crisis
52
how are steroids used for antineoplastic effects?
prednisone/prednisolone can be sole palliative treatment for lymphoma (different if doing chemo) effective against other round cell tumors like multiple myeloma and mast cell tumor palliative for other neoplasias, though NSAIDs often recommended for carcinomas
53
when should you not give a patient steroids?
fungal and viral infections gastrointestinal ulceration osteoporosis late pregnancy corneal ulcers diabetes mellitus (relative) procoagulant states (relative)
54
why should we not use steroids for a patient with a fungal infection (systemic mycoses)?
diseases held in check by cell-mediated immunity: severely inhibited by steroids
55
why should we not use steroids in patients with gastrointestinal ulceration?
may result in ulcer development or aggravate an existing ulcer
56
is it okay to use NSAIDs and steroids together?
no significant risk of ulceration/perforation if used together
57
what animals are most prone to steroid-induced abortion?
cattle mid-gestation on, especially last month
58
why should you be hesitant to use steroids in a patient with diabetes mellitus?
glucocorticoids have an anti-insulin effect regulation of diabetic difficult
59
what is an aldosterone antagonist?
spironolactone
60
what antagonizes cortisol synthesis?
trilostane (vetoryl): inhibits enzyme in cortisol synthesis pathway mitotane (lysodren): adrenolytic; cytotoxic to adrenal zona fasciculata and reticularis
61
what is a dopamine agonist?
pergolide mesylate
62
dexamethasone is __________ as potent as prednisone
7 times
63
true/false: steroids are used to enhance wound healing
false
64
are mineralocorticoids or glucocorticoids used primarily for hypoadrenocorticism?
mineralocorticoids
65
what does corticotropin releasing hormone lead to?
adrenocorticotropic hormone and then cortisol
66
what is aldosterone involved in?
maintaining electrolyte and fluid balance
67
what is the potency of predisolone?
glucocorticoid: 4 mineralocorticoid: 0.8
68
what is the potency of dexamethasone?
glucocorticoid: 30 mineralocorticoid: 0
69
what is the biological half-life of prednisolone?
12-36hr
70
what is the biological half-life of dexamethasone?
36-54hr
71
what are some base words to show drugs are IM repository?
acetate pivalate
72
what are some other adverse effects of glucocorticoids? other than pu/pd/pp, panting, alopecia, increased ALP
inhibit wound healing increased susceptibility to infection decreased response to vaccination diabetes laminitis in horses GI ulceration may cause abortion muscular weakness calcinosis cutis hypertension CHF worsen proteinuria pancreatitis?
73
what are the positives of budesonide as an alternative glucocorticoid?
potentially fewer systemic side effects still suppresses HPA axis
74
fluticasone causes suppression of HPA axis in _________________________
dogs, but not cats
75
what diseases should you consider fluticasone for?
feline asthma canine chronic bronchitis
76
why do we think some steroids cause laminitis in horses?
not sure, but may be due to sensitization of alpha receptors in hoof wall
77
what drugs are less likely to cause abortion in cattle?
prednisolone isoflupredone
78
does potency play a role in choosing a steroid for anti-inflammatory or immunosuppressive purposes?
no
79
what should you choose a steroid for anti-inflammatory or immunosuppressive purposes by?
whether or not want mineralocorticoid effects duration of action desired if tissue distribution is an issue species differences
80
what mineralocorticoids are used in addison's disease?
DOCP fludrocortisone
81
why is prednisolone preferred for the glucocorticoid in addison's?
has mineralocorticoid activity: can reduce dose of DOCP or fludrocortisone
82
what drugs increase production of lipocortin (which inhibits phospholipase A2)?
glucocorticoids
83
what is the duration of therapy for anti-inflammatory therapy (short)?
2-3 days: control pruritis single dose dexamethasone one week of prednisolone
84
what are the positives of doing alternate day therapy with long-term anti-inflammatory therapy?
less immunosuppression less pituitary-adrenal axis suppression any nonrepository steroid can be used early one
85
why do we try to avoid repository injections?
highs are too high, lows too low less control more adrenal suppression repeating infections prone to cause iatrogenic hyperadrenocorticism in dogs
86
what is the dose of prednisolone for horses?
50-100mg IM/IV per horse PO similar to dogs
87
what is the dose of dexamethasone for cows?
5-20 mg IM/IV per cow 0.02-0.04 mg/kg IM for many indications
88
how many half-lives should you wait between NSAIDs and steroids?
5 half-lives if cannot: consider misoprostal
89
what can happen with a pregnant bitch placed on high doses of steroids?
fetal death reabsorption in first half of gestation or abortion thereafter
90
why should you avoid steroids in animals predisposed to thromboembolism?
animals with hyperadrenocorticism are predisposed to sudden death from thromboembolism: evidence that this occurs with exogenous steroids as well
91
what should you treat hyperaldosteronism with?
spironolactone: aldosterone antagonist
92
what is the drug of choice for canine and feline cushings?
trilostane
93
how is equine cushings treated?
dopamine agonists pergolide mesylate

Basic Pharmacology (37 decks)

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