L 29 Glucocorticoids

Question 1

Short acting Glucocorticoids?

Answer 1

Cortisone

Hydrocortisone

Question 2

Intermediate acting Glucocorticoids?

Answer 2

Prednisone
Prednisolone

Trimcinolone

Methylprednisolone

Question 3

Long acting Glucocorticoids?

Answer 3

Betamethasone

Dexamethasone

Question 4

What is the endogenous steroidal anti inflammatory? What is the source?

Answer 4

Cortisol

Adrenal Gland – Fasciculata

Question 5

What are Glucocorticoids synthesized from?

Answer 5

Cholesterol

Question 6

What is the HPA Axis?

Answer 6

Hypothalamus CRH

Ant. Pit ACTH

Adrenal Cortex

-> Cortisol

Question 7

What is the difference between Cortisol & Dexamethasone?

Answer 7

Dexamethasone can inhibit HPA

Question 8

What do Glucocorticoids negatively regulate?

Answer 8

HPA axis

CRH, ACTH secretion

Question 9

Glucocorticoid MOA?

Answer 9

Ligand binds to cytosolic receptor

ligand/ receptor complex translocates to nucleus & binds to DNA

transcription of mRNA

Ptns are translated that induce effects of Gluco.

Question 10

What are Glucocorticoid effects?

Answer 10

normal metabolism

Inc. stress resistance

alter blood cells

anti- infl

effects on other endocrine

Question 11

Glucocorticoids can cause a modest rise in?

Answer 11

BP

Question 12

How do Glucocorticoids alter circulating blood cells?

Answer 12

DEC.

eosinophils
basophils
monocytes

redistribute them to lymphoid tissue

INC.

hemoglobin
erythocytes
platelets

Question 13

What are Glucocorticoids anti-inflammatory actions?

Answer 13

(-) phospholipase A2 by activating Lipocortin

Dec. activity of peripheral lymphocytes & macrophages

Interfere in mast cell degranulation = dec histamine & cap perm

Question 14

What does Glucocorticoid do to other endocrine hormones?

Answer 14

Dec. TSH

Inc. GH

Neg feedback (-) further glucocorticoid synthesis

Question 15

What are synthetic corticosteroids primarily bound to?

Answer 15

albumin

Question 16

Glucocorticoid therapy should be monitored in pt w/?

Answer 16

hepatic dysfunction

Question 17

Why is the plasma 1/2 life shorter than the biological 1/2 life?

Answer 17

effects persist due to the ligand receptor complex sticking around vs plasma membrane receptor desensitization

Question 18

How is the potency defined?

Answer 18

ability to raise blood glucose

Question 19

What is the primary mineralocorticoid?

Answer 19

Aldosterone

Question 20

What do mineralocorticoids promote?

Answer 20

Na retention in kidney

affect BP

Question 21

What are mineralocorticoids effects based on?

Answer 21

Na retention

Question 22

What happens with large doses over an extended periods of time?

Answer 22

HPA axis suppression

Question 23

What should the dose regime be?

Answer 23

alternate day therapy

Question 24

What inflammatory diseases do Glucocorticoids Tx?

Answer 24

eczema, dermatitis

arthritis, bursitis, tenosynovitis

ulcerative colitis, Crohn’s

asthma, COPD

Question 25

How do Glucocorticoids inhibit the immune system?

Answer 25

autoimmune diseases organ transplant during surgery allergic conditions lupus

Question 26

What are Glucocorticoids other uses?

Answer 26

cerebral edema premature delivery = dec res. & neonatal mortality eye injury = (-) fibrosis replacement therapy = Addison's

Question 27

What are Adverse Effects?

Answer 27

Osteoporosis Cataracts Hyperglycemia Infection Resist. Dec Fluid & Electrolyte imbalance PUD Body Fat Redistribution Muscle Mass Loss Adrenal Suppression

Question 28

Why is Osteoporosis caused?

Answer 28

suppression of intestinal Ca2+ absorption

Question 29

What is the cause of Addison's disease?

Answer 29

insufficient Glucocorticoid production

Question 30

Addisons symptoms?

Answer 30

chronic fatigue muscle weak wt. loss appetite loss

Question 31

Addisons Tx?

Answer 31

Replacement therapy w/ Glucocorticoids

Question 32

Cushing's syndrome cause?

Answer 32

excess glucocorticoids

Question 33

Cushing's disease?

Answer 33

Pituitary over secretion of ACTH

Question 34

What does long term Glucocorticoid tx mimic?

Answer 34

Cushing's syndrome

Question 35

Cushing's syndrome symptoms?

Answer 35

wt. gain in trunk, face, & growth of fat pads in collarbone central obesity, buffalo humor, moon face easy bruising, skin atrophy acne hirusitism

Question 36

How to determine primary cushing's syndrome from secondary cushing's disease?

Answer 36

ACTH level test Primary Cushing's syndrome = CRF overproduction Secondary Cushing's Disease = ACTH over production