Steroids Flashcards
(106 cards)
1
Q
Most important mineralocorticoid
A
Aldosterone
2
Q
Major adrenal androgen
A
DHEA
3
Q
Major endogenous precursor of estrogen in women after menopause
A
Adrenal androgen
4
Q
Glucocorticoid synthesized from
A
Cholesterol
5
Q
Glucorticoids rate of secretion follows __________ governed by pulses of _______
A
Circadian rhythm
ACTH
6
Q
Glucorticoids in plasma bound to circulating
A
Protein
7
Q
Glucorticoids
In plasma also
Alpha 2 globulin synthesized by the liver, 90% of circulating hormone
A
Corticosteroid binding globulin
8
Q
Glucorticoids
I plasma also, remaining free or loosely bound to
A
Albumin
9
Q
Glucorticoids
Large capacity
Decrease affinity for cortisol
A
Albumin
10
Q
Largely bound to albumin than CBG
A
Synthetic corticosteroids (dexamethasone)
11
Q
Glucorticoids
1% excreted unchanged as free
A
Cortisol in urine
12
Q
Cortisol
20% converted to cortisone by
A
11 hyroxysteroid dehydrogenase
13
Q
Cortisol
Metabolism in
A
Kidney
14
Q
Cortisol
Excreted as
A
Dihydroxy ketone
15
Q
Cortisol
Measured as
A
17 hydroxysteroids
16
Q
Cortisol
Conjugated with
A
Glucoronic acid or
Sulfate
17
Q
2 genes for corticoid receptor
A
Glucorticoids receptor
Mineralocorticoid receptor
18
Q
Classic ligand activated glucocorticoid receptor
A
Hgr alpha
19
Q
Dose not bind glucocorticoids
Inhibit effects of hormone activated hGR
A
hGR beta
20
Q
Glucocorticoid binding domain
A
Carboxyl terminal
21
Q
Cortisol
DNA binding domain
A
Middle of CHON
9 cysteine residues
2 fingers
ZINC
22
Q
Transactivation activity of receptor
Increase specificity
A
Amino terminal domain
23
Q
Cortisol
Steroids receptor co regulators
A
Co activator
Co repressors
24
Q
Cortisol
Physiologic effect
Homeostatic responses by
A
Insulin and glucagon
25
Cortisol
Stimulate in fasting state
Gluconeogenesis
| Glycogen
26
Cortisol
Metabolic effects
Gluconeogenesis
Lipogenesis
Lipolysis
27
Cortisol
| Catabolic and anti anabolic effect on bone
Osteoporosis
| Cushing syndrome
28
Catabolic and anti anabolic effects on children
Decrease growth
29
Cortisol
Effect in inflammation
Function of leukocyte
Suppress cytokines and chemokines
Increase neutrophils
Decrease lymphocyte, monocyte, eosinophils and basophils
30
Cortisol
Anti inflammatory and immunosupresive effect
Lahat decrease, macrophage
Antigen or mitogen response
Prostaglandin (kaya na activate si phospholipase A2)
Mast cell
Capillary permeability
Decrease din si histamine na nag rerelease ng basophils
Except, kasi sya lang ang increase
Neutrophils
Kapag nakita mo si leukocytes, sama mo na rin
31
Increase amount of glucocorticoids
Initially - insomnia and euphoria lead to deppresion
| Late- increase ICP (pseudo tumor cerebri)
32
Cortisol
If given chronically it will suppress
ACTH
Growth hormone
TSH
LH
33
Cortisol
If given in large dose for
Peptic ulcer
| Fat redistribution Antgonize effect of vitamin D on Ca absorption
34
Cortisol deficiency
Basta may kinalaman sa pag ihi
35
Synthetic corticosteroids
Source
Cholic acid
36
Synthetic corticosteroids
Prednisone rapidly converted to active product
Prednisolone
37
Adrenocortical insufficiency
Acute and chronic Addison disease
38
Chronic Addison
Characterized by
Weight loss
Hypotension
Hyperpigmentation
Inability to maintain blood glucose during fasting
39
Chronic Addison
Primary adrenal insufficiency
Hydrocortisone
40
Chronic Addison
Supplemented by
Fludrocortisone a salt retaining hormone
Synthetic long acting and devoid of salt retaining activity should not be administered
41
Acute Addison
Immediate treatment
Large amount of parenteral hydrocortisone like
Sodium succinct and phosphate
Pwede ka mag bigay ng salt retaining hormone kung ang hydrocortisone level mo ay 50mg/day na
42
Adenocortical hypo and hyper function
Congenital adrenal hyperplasia
Cushing syndrome
Aldosteronism
43
Congenital adrenal hyperplasia
Cause
Decrease or lack of 21 beta hydroxylase activity
| Increase 17 hydroxy progesterone
44
Congenital adrenal hyperplasia
If defects is in 11 hydroxylation
Increase deoxycorticosterone that leads to
HPN with or without hypokalemia
45
Congenital adrenal hyperplasia
If defect is in 17 hydroxylation (adrenal and gonads)
Hypogonadism
46
Congenital adrenal hyperplasia
Best treatment for infant
IV hydrocortisone
47
Congenital adrenal hyperplasia
For stabilized patient
Oral hydrocortisone
48
Congenital adrenal hyperplasia
Greater ACTH suppression with increasing growth hormone
Prednisone
49
Congenital adrenal hyperplasia
Orally with added salt to maintain BP, renin activity and electrolytes
Fludrocortisone
50
Cushing syndrome
Result of bilateral adrenal hyperplasia secondary to
ACTH secreting pituitary adenoma
51
Cushing syndrome
Treatment
Surgery
Radiation
Resection
Drug- 300 mg soluble of Hydrocortisone ( continous on the day of surgery dapat slow lang ha.
52
Cushing syndrome
If rapid reduction of hydrocortisone
Withdrawal syndrome
Joint pain
Fever
53
Aldosteronism
Primary aldosteronism
Clinical findings
```
HPN
Weakness
Tetany - dahil sa renal loss of K
Hypokalemia
Alkalosis
Increase Na
```
54
Aldosteronism
Secondary aldosteronism
Decrease renin and angiotensin 2 activity
55
Aldosteronism
Treated with
Fludrocortisone or
| Deoxycorticosterone acetate IM for 3 days
56
Aldosteronism
Diagnostic and therapeutic
Spironolactone
57
Diagnosis of Cushing syndrome
Dexamethasone suppression test
58
Urine is assayed for cortisol or metabolites
Liddle's test
59
Lung maturation in the fetus
IM betametasone
60
Medium and intermediate acting Glucorticoids
Prednisone and prednisolone
61
Prolonged therapy is anticipated
CXR and tuberculin test for TB
62
Major undesirable effect
Iatrogenic Cushing syndrome
63
Patients treated with glucocorticoids should be on
Increase CHON and potassium enriched diets
64
Aldosterone
Synthesized in
Zona glomerulosa
65
Aldosterone
Produce stimulation of its release
ACTH
66
Decrease section of Cortisol while increasing secretion of aldosterone
Decerebration
67
Aldosterone
Promotes
Reabsorption of Na in distal convoluted and cortical collecting tubules
Excretion of K and hydrogen
68
Precursor of aldosterone
Deoxycorticosterone
69
Deoxycorticosterone DOC for
Adenocortical carcinoma
| Congenital adrenal hyperplasia
70
Potent steroid with both glucocorticoid and mineralocorticoid activity
Fludrocortisone
71
DHEA additional effects
Interaction with GABA and glutamate receptors
LUPUS
Women with adrenal insufficiency
72
Blocks conversion of cholesterol to pregnenolone
Aminoglutethimide
73
Aminoglutethimide
Decrease or eliminate estrogen production in patients with
Carcinoma of the breast
74
Aminoglutethimide
Adverse effect
Lethargy and skin rash
75
Aminoglutethimide
Can be use in conjunction with
Metyrapone or
| Ketoconazole
76
Aminoglutethimide
Decrease secretion in patients with Cushing do not respond to
Mitotane
77
Aminoglutethimide
Enhance metabolism of
Dexamethasone
78
Anti-fungal imidazole
Ketoconazole
79
Potent, nod selective inhibitor of adrenal and gonadal steroid synthesis
Ketoconazole
80
Ketoconazole
Treatment
Cushing syndrome
81
Ketoconazole
Adverse effect
Hepatotoxicity
82
Selective inhibitor of steroid 11 hydroxylation, interfering with corticosterone synthesis
Metyrapone
83
Metyrapone
Related to
ACTH
84
Metyrapone
| Adverse effect
Transient dizziness and GIT disturbance
85
The only adrenal inhibiting medication that can be administered to pregnant women with Cushing syndrome
Metyrapone
86
Metyrapone
Major adverse effect
Salt and water retention
| Hirsutism
87
Metyrapone
Pituitary function
Midnight orally
| Blood drawn at 8am
88
38 hydroxysteroid dehydrogenase inhibitor
Trilostane
89
Trilostane
| Adverse effect
Gastrointestinal
90
Newest of the steroid inhibitors
Arbiraterone
91
Arbiraterone
Blocks
17 alpha hydroxylase and 17,20layse
92
Arbiraterone
Prevented by concomitant administration of
Dexamethasone
93
Arbiraterone
Treatment
Refractory prostate cancer
94
RU 486
| Antagonist at steroid receptor
Mifepristone
95
Mifepristone
Blocking the
Glucocorticoid receptors
96
Mifepristone
Bind to
Albumin
No affinity to CBG
97
Drug related to DDT class of insecticides
Mitotane
98
Mitotane
Non selective cytotoxic action on adrenal cortex in
Dogs
99
Mitotane
Treatment
Adrenal carcinoma
100
Mitotane
Adverse effect
Diarrhea
101
Antagonist of mineralocorticoids
Spironolactone
Eplerenone
Drospirenone
102
Spironolactone
7 alpha acethylthispironolactone
| Slow onset
103
Spironolactone TREATMENT
Primary aldosteronism
| Hirsutism in women
104
More selective than Spironolactone
Eplerenone
Adverse effect for hyperkalemia
Treatment for hypertension
105
Antagonize the effect of aldosterone
Drospirenone
Progestin
Oral contraceptive
106
Major glucocorticoid
Cortisol
