Test 5 Flashcards
1
Q
What are hormones?
A
Chemical regulators of cellular function
2
Q
Where are hormones synthesized?
A
Endocrine glands
3
Q
What happens after hormones are produced?
A
They are put into circulation (released)
4
Q
How do hormones act on target tissues?
Through what?
A
Through specific receptors
5
Q
What are the three types of hormones?
A
Amino acid based hormones
Eicosanoids
Steroidal hormones
6
Q
What kind of hormones are insulin, GH, and catechols?
A
Amino acid based hormones
These are AAs, peptides, proteins, and catecholamines
7
Q
What kind of hormones are prostaglandins?
A
Eicosanoids
Locally acting and locally secreted
8
Q
What kind of hormones are adrenocortical and gonadal hormones?
A
Steroids
9
Q
What are steroids deratives of?
A
Cholesterol
10
Q
What kind of steroid hormones are cortisol and aldosterone?
A
Adrenocortical hormones
11
Q
What kind of steroid hormones are estrogen and testosterone?
A
Gonadal hormones
12
Q
What kind of receptors do steroidal hormones act on?
A
Intracellular/nuclear hormones
They are lipid soluble so pass through membrane
13
Q
Which acts faster, plasma membrane receptors or intracellular receptors?
A
Plasma membrane receptors
They do not have to do with gene transcription which is slow
14
Q
What kind of responses would steroid hormones produce when binding to a receptor?
A
Gene suppression or activation
Also thyroid hormones as well
15
Q
How does a steroid get to the intracellular receptor?
A
Pass through plasma membrane into the cytosol and bind to intracellular receptor to form the hormone receptor complex
16
Q
How do steroids affect gene transcription activity?
A
The hormone receptor complex interacts with DNA and affects gene transcriptional activity to cause transcription of mRNA and Synthesis or translation of protein
17
Q
Are steroidal hormones packaged?
A
No they are synthesized and immediately released
18
Q
Where are the enzymes that produce steroids located?
A
Mitochondria and smooth ER
19
Q
How do hormones get transported throughout the body?
A
Bound to binding globulins to get transported by the blood
20
Q
What binding globulin carries cortisol?
A
Corticosteroid binding globulin
21
Q
What globulin carries estradiol and testosterone?
A
Sex steroid Binding globulin
22
Q
What converts steroids to active form if they are not already activated?
A
The target cell
23
Q
What are the three main roles of steroidal hormones in physiological function?
A
Carbohydrate regulation
Mineral balance
Reproductive steroids
Glucocorticoids
Mineralocorticoids
Gonadal steroids
24
Q
What kind of steroid helps with inflammation response, stress response, bone metabolism, behavior and mood?
A
Glucocorticoids
25
What is the hypothalamus made up of?
Neurosecretory hormone secreting cells of the posterior pituitary via the infudibular stalk
26
What does the hypothalamus do?
Release releasing and inhibiting factors that act on cells in the anterior pituitary via the hypopheseal portal system
27
What is the pituitary made up of?
Cells that produce hormones that are released into the blood stream
| Anterior and posterior sections have different functions
28
What is the posterior pituitary comprised of?
The endings of axons from cell bodies in the hypothalamus that are released into the posterior pituitary
29
What are the principal hormones of the posterior pituitary?
ADH/ vasopressin
Oxytocin
30
What does ADH do?
Regulate fluid levels (increase water reabsorption in the kidneys)
## Footnote
This would increase blood pressure- also called vasopressin
31
What does oxytocin do?
Cause milk ejection and uterine contraction
32
How are the hypothalamus and pituitary gland connected?
Via blood vessels that converge at the median eminence at the base of the hypothalamus
| Hypophyseal portal system
33
What is released from the hypothalamus?
Releasing factors
Inhibiting hormones
34
What do releasing hormones do?
Cause release of hormones by the anterior pituitary
35
What do inhibiting hormones do?
Inhibit secretion of hormones by the anterior pituitary
| DA
Somatostatin
36
What are the Anterior pituitary hormones?
ACTH
GH
Prolactin
TSH
FSH
LH
37
What does ACTH do?
Stimulates cortisol secretion by adrenal cortex
38
What is CRF/CRH?
Corticotropic releasing factor/hormone
39
What does CRF do?
Regulates ACTH secretion from Anterior pituitary which causes release of cortisol into the blood
40
What stimulates release of ACTH?
CRF or CRH release
41
What inhibits CRH?
ACTH and cortisol
42
What inhibits ACTH?`
Cortisol
43
What is hyposecretion?
Too little of the hormone produced
| Less than normal response
## Footnote
Hypothyroidism
44
What is hypersecretion?
Excess hormone produced
| exaggeration of normal effect
## Footnote
Hyperthyroidism
45
What is the primary pathology of hormone secreting glands?
Damage to hormone secreting glands
| Tumor or death cells
Addison's
CAH
46
What kind of disease is Addison's Disease?
An autoimmune
47
What kind of disease is adrenal hyperplasia?
Autosomal abnormality
48
What is the secondary pathology caused for hypersecretion?
Damage to the control systems and mechanisms
| Caused by pituitary adenomas
49
What happens/side effects are caused by Hyperpituitarism?
| Adenomas
Visual field changes
Increased intraocular pressure
| Pushes the optic neuronal tracks
Effects ACTH, GH, and prolactin
50
What causes hypopituitarism?
Destruction of the pituitary
51
What is the most common cause of destruction of the anterior pituitary?
Panhypopituitarism
| Loss of AcTH, TSH and is life threatening
## Footnote
Non secretory pituitary adenomas
52
What are the layers of the adrenal cortex?
Zona glomerulosa- outer
Zona fasciculata- middle
Zona reticularis- inner
53
What is produced by the adrenal cortex?
Steroid hormones
54
What does the zona reticularis produce?
Gonadal steroids
| Adrogens to be converted to estrogens in females
55
What does the zona glomerulosa produce?
Mineralocorticoids
| Ion
H2O balance
Aldosterone
56
What does the zone fasciculata produce?
Glucocorticoids
| Glucose metabolism
Cortisol
57
What does cortisol do for the body?
Helps with blood glucose levels unders stress
Increase gluconeogenesis also in the liver
Decrease the immune response
58
What is cortisol stimulated by?
CRH and ACTH
59
When is cortisol produced?
| Under what body condition
Stress
| Low plasma glucose concentration
60
What are the actions of glucocorticoids mediated by?
| What receptor
Glucocorticoid receptor
61
What super family is the human Glucocorticoid receptor under?
Transcription factor proteins
## Footnote
Steroid, thyroid, retonic acid nuclear receptor superfamily
62
What do these transcription factors do?
Regulate the expression of glucocorticoid responsive element GRE either positively or negatively
63
What happens when the GR is activated?
Receptors translocate to the nucleus to alter gene transcription by binding to specific response elements
64
What are glucocorticosteroids blocked by?
11 Beta HSD
Inactivates them
65
What is the inactive form of cortisol?
Cortisone
66
From studies of GR knock out in mice, what is GR necessary for?
Lung development for producing surfactant
Regulation of liver, adrenal glands, brain, and HPA axis
67
What kind of regulatory hormone are glucocorticoids?
| In terms of biological effects on carbs, proteins and lipids
Significant counter-regulatory hormone to insulin
68
What do glucocorticoids do for the carbohydrates, proteins, and lipid metabolism?
Mobiize amino acids for hepatic gluconeogenesis
Increase blood glucose concentration
Increase lipolysis in adipose tissue
Inparts insulin resistance cells and increasing permissiveness
69
What do glucocorticoids do for the skin?
Regulate epithelial integrity and immune function
70
What are Glucocorticoids used for to treat the skin?
Inflammation caused by eczema, hives, allergies, and psoriasis
| Side effects- skin atrophy, and delayed wound healing
71
What do glucocorticoids do for circulation?
Maintains body fluid volumes and vascular integrity
| Sensitizes arterioles to action of NE
## Footnote
Decrease capillary permeability
Maintain normal renal function
Minaralocorticoid effects from cortisol
72
What does cortisol do for blood pressure?
It increases blood pressure by sodium retention and volume expansion
## Footnote
Intrinsic mineralcorticoid activity
Increase vascular smooth muscle sensitivity
Decrease NO
Increases RAAS
73
What does cortisol do for calcium metabolism?
Inhibits osteoblastic function
| Decreases the ability to add new bone
## Footnote
Causes osteoporosis and osteopenia
74
What is Addison's disease caused by?
Cortisol insufficiency
75
What is primary Addison's disease caused by?
Cortisol insufficiency due to the loss of ability to make cortisol in adrenal gland
| Increases ACTH levels and there is no feedback
Increase in MSH
## Footnote
Hyper pigmentation
76
What is secondary Addison's disease caused by?
Decrease in ACTH
Decrease CRH
| Loss of function in hypothalamus
## Footnote
Rapid withdraw from steroids
77
What might cause Addisonian Crisis?
Adrenal insufficiency
| Weakness
Fatigue
Hypotenion
GI probs
Hypoglycemia
## Footnote
Increase in K decrease in NA
78
What might cause Addisonian Crisis?
Adrenal insufficiency
| Weakness
Fatigue
Hypotenion
GI probs
Hypoglycemia
## Footnote
Increase in K decrease in NA
79
What causes Cushing's Syndrome?
Hypersecretion of ACTH and Cortisol
80
What causes an increase cortisol release
Tumor
81
What causes an increase in ACTH release?
Tumor in lungs, pituitary gland, kidneys, and pancreas
82
What causes ectoptic release by neoplasias?
Lung cancer
83
What causes Iatrogenic Cushing's Syndrome?
Exogenous Glucocorticosteroid Administration
84
What does excess release of GCs cause?
Osteoporosis
Cataracts
Skin thinning/ cutaneous striae
Decrease proteins and myopathies
Connective tissue breakdown
Blood changes
CNS effects
85
How does Cushing's disease affects lipid distribution?
Causes an increase in weight
Trunkal obesity
Moon facies
Buffalo hump
86
What happens to the skin in Cushing's Disease?
Fragility
Easy bruising "cutaneous striae"
87
What does Cushing's disease do when an infection occurs?
Masks them through anti inflammatory actions
88
What does cushing's syndrone cause metabolically?
Water and salt retention
Increased glucose concentration
Increased osteoclasts and decreased osteoblasts
| Hypertension
Hyperglycemia "steroidal diabetes"
Bone atrophy muscle too
89
What are glucocorticoids mainly used for?
Their anti-inflammatory effects
90
What does glucocorticoid use do to the production of eosinophils and prostaglandins?
Inhibit them
91
What enzyme do glucocorticoids inhibit to stop the production of prostaglandins?
Phospholipase A2
92
What are the ways glucocorticoids cause decrease in inflammation?
Inhibit phospholipase A2
Decrease permeability of capillary membranes
Decrease swelling
Decrease histamine effect
93
How do glucocorticoids suppress the immune system?
Decrease Tcell and antibody production
Decrease eosinophils and lymphocytes
Inhibit macrophage and neutrophil function
Decrease immunity
94
When would inhaled glucocorticosteroids be prescribed ?
| What disease state
Asthma
Chronic respiratory inflammation
95
How do inhaled glucocorticosteroids inhibit the inflammatory response of asthma?
Inhibit NF-kV and activator protein 1 activity which is a transcription factor
| Decrease production and secretion of cytokines, chemokines,cell adhesion
96
What are glucocorticoid agonists used for?
Adrenal insufficiency
Inflammatory disorders
Autoimmune disorders
| Addison's
Asthma/skin
RA, IBS, MS
97
When are glucocorticoid antagonists used?
Cushing's disease or syndrome
98
What is the primary naturally occuring steroid in the body?
Hydrocortisone
| Taken orally
99
What is the prodrug for prednisolone?
Prednisone
100
When is prednisolone usually chosen?
Chosen for anti-inflammatory
| Little sodium retention
101
What kind of glucocorticosteroid is Triamcinolone?
Flurinated glucocorticosteroid
| No sodium retaining effect
102
Triamcinolone has a serious adverse effect, what is it and what is a good part of triamcinolone at lower doses?
Bad- causes muscle wasting
Good- low sodium retention
103
What two drugs are usually chosen over prednisolone because they are longer acting?
Dexamethasone
Betamethasone
104
When would you use glucocorticoid for replacement therapy?
Acute adrenal insufficiency
Chronic adrenal insufficiency (addison's)
Congential adrenal hyperplasia (autosomal)
105
What is the main problem with using glucocorticoids for non endocrine disorders?
They have good effects but the same amount of side effects
106
What kind of steroid is aldosterone?
Mineralocorticoid
## Footnote
No place in routine therapy
too much first pass metabolism
used for sodium retention
107
What is used instead of aldosterone in practice?
Fludrocortisone
Large sodium retention
| long acting flourinated
## Footnote
Replace aldosterone where adrenal cortex is destroyed (addisons)
108
What does long term use of corticosteroids do?
Cause long term suppression of the HPA axis so they need to be tappered off
109
What is addisonian crisis?
Acute adrenocortical insufficiency
Emergency
110
What is the most common cause of Adrenal crisis?
HPA axis suppression / abrupt with drawal
111
What can treat Addison's?
Hydrocortisone
Prednisone
112
What is the goal in treating addisons disease?
Establish an effective dose while mimicking normal diurnal adrenal rhythm (cortisol is highest in the morning)
113
Why is hydrocortisone used the most to treat addison's disease?
Because it has both mineralocorticoid and glucocorticoid activity and in addison's disease aldosterone is lost too
114
What happens in cushing's syndrome?
Too much cortisol either exogenously or endogeneously
115
What is their too much of in ectopic or lung tumors?
ACTH
116
What kind of tumors cause too much cortisol?
Adrenal tumors
| Adrenal hyperplasia
117
WHat is the most common way to diagnose chushings?
The 24 hours urinary free- cortisol test
| Collect urine over 24 hours and test cortisol levels
IF high then yes
118
What are the three main forms of treatment for cushings?
Surgery of tumor
Radiation Therapy
Medications
119
What medications are used to treat cushings?
Steroidogenic inhibitors
120
What do steroidogenic inhibitors do?
Uses medications that inhibit enzymes required for synthesis of corticosterone and cortisol
| Inhibition of 11 beta hydroxylase
121
What is Metyrapone used for?
Cushings disease
122
What does metyrapone do?
Inhibits 11 beta hydroxylase in the adrenal gland
123
What does Osilodrostat do?
Inhibition of 11 beta hydroxylase
| For those who cannot have surgery or it did not work
124
What does ketoconazole do?
Normally for fungal infections
Inhibits the P450 enzyme system which then inhibits the 11 Beta hydroxylase
125
What does Mitotane do?
Inhibits 11 hydroxylation and pregenolone synthesis from cholesterol in. thecortex
## Footnote
Could have life threatening side effects since it is an anti neoplastic agent
126
What is Pasireotide?
Somatostatin analog that is universillay an inhibitor
127
what does Pasireotide do?
Acts via somatostatin receptors to inhibit secretion of corticotropin from pituitary adenomas with Cushings disease
| Somatostatin receptor type 5?
128
what does Pasireotide do?
Acts via somatostatin receptors to inhibit secretion of corticotropin from pituitary adenomas with Cushings disease
| Somatostatin receptor type 5?
129
What is the main side effect of Pasireotide?
Hyperglycemia
130
What kind of effect do topical steroids have?
Topical anti inflammatory effect
131
What are the main topical steroids?
Hydrocortisone
Prenisolone and methylpred
Dexa and Betamethasone
Triamcinolone
Fluocinonide
132
How war topical steroids ranked?
In classes from 1 to 7 based on potency with 1 being the most potent
133
What do ointments treat?
Dry thick lesions
134
What kind of effect do creams have?
Anti inflammatory with a little bit of drying
| Good for sensitive areas
135
What kind of agent are lotions and gels?
Occlusive and they have alcohol so drying as well
| Good on hair
136
What potency should you use on the face?
Decrease side effects by lowering the potency
137
What are side effects related to?
Frequency
Potency
Duration of use
Anatomical site of application
138
what is Asthma?
Chronic inflammatory disease of airways (bronchials) increase in responsiveness allergens
139
WHat are the features of asthma?
Inflammation of bronchial walls and inflammation cell infiltration
Reversible airflow obstruction
Increase in mucous
140
When do asthma attacks normally occurr?
At night
141
What are the immune responses you see with asthma?
Inflammatory cell infiltration
Mast cell activation
Edema
Denudation of airway epithelium
Collagen deposition beneath the basement membrane
142
What causes Atopy?
Too much IgE
| Inflammation response
143
What kind of response is the early phase of airway inflammation?
Bronchospasm Response
release of inflammation mediators from mast cells macrophages and epithelials
144
What kind of inflammation happens in the secondary dip for asthma attacks?
Chemotactic inflammation
145
What are the primary mediators?
Histamine
146
What are the secondary mediators?
Leukotrienes
Prostaglandins
147
What does the mediator soup cause?
Bronchoconstriction
Microvascular Leakage
Mucus Hypersecretion
Airways Hyperresponsiveness
148
What kind of steroids are used as quick relief medications for asthma?
Systemic steroids
Oral or IV
## Footnote
Gain control of moderate to severe acute exacerbations
149
What are the two main systemic steroids?
Prednisone and prednisolone
## Footnote
Acutely speed resolution of airflow obstruction
150
What is used for controller medications for asthma?
Inhaled Glucocorticoids
151
What must be taken with LABAs?
Inhaled Glucocorticoids
| MOmetasone
Fluticasone
152
What do inhaled glucocorticoids do?
Decrease Bronchial Hyperreactivity
## Footnote
Decrease dependency on SABAs for sympathetic relief
Increase pulmonary function
Increase quality of life
153
What is the mechanism of action of inhaled corticosteroids?
Suppress cytokine production
Decrease eosinophil function
Inhibits macrophages and release of cytokine inflammation
Stablizes endothelial membranes
154
What are the respiratory corticosteroid inhalation products?
Budesonide
Ciclesonide
Beclomethasone Dipropionate
Mometasone
155
Why is Flonase good for inhalation?
It is rapidly metabolized by the liver (3A4) so it has little systemic side effects if swallowed
156
What are the main side effects of inhaled corticosteroids?
Deposition in mouth and throat that may increase oral candidiasis
Stop this by rinsing after use
157
Why do you not use ICS for COPD?
The side effects outweigh the benefits
158
What cell types are found in asthma?
Mast cells
Eosinophils
CD4+ T cells
Macrophages
159
What cell types are found in COPD?
Neutrophils
CD8+
T cells
Many macrophages
160
What effects are different between COPD and Asthma?
Asthma only effects bronchials and then COPD effects bronchials and alveoli
