Wednesday - Adrenal Pharm - Trachte Flashcards Preview

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Flashcards in Wednesday - Adrenal Pharm - Trachte Deck (18)
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1
Q

What do you use glucocorticoids for? (as treatment)

A
immune suppressants
vascular disorders
renal disorders
organ transplant
allergies
so many things
2
Q

How do glucocorticoids have anti-inflammatory effects

A

reduce cox-2
decrease white blood cell concentration
reduce edema
block vasodilation

3
Q

How are glucocorticoids anti-allergic

A

block production of histamine and effects of histamine receptor!

4
Q

how are synthetic glucocorticoids more potent than cortisol?

A

less protein bound
slower metabolism
higher glucocorticoid effect and less mineral effect
have a flouride group

5
Q

which glucocorticoid has a lot of mineralcorticoid activity?

A

fludrocotisone

6
Q

What are the side effects of taking a lot of glucocorticoids?

A

cushing syndrome

7
Q

Glucocorticoid effects on white blood cells

A

lymphocytes decrease

neutrophils actually increase (because you block extravasation into tissue)

8
Q

what happens to cortisol if you shotgun a gallon of liquid licorice?

A

licorice blocks conversion of cortisol to cortisone, so the effects are like cushings

9
Q

If you are suspecting hypocortisolism, how to you test it?

A

short ACTH (tetracosactide) test

if you give that and cortisol level goes up, then the adrenals are functioning

10
Q

if short acth test is sub normal, you do the long test. What does that tell you?

A

In addison’s, cortisol level would be low always

in secondary insufficiency, increase in cortisol is eventually seen. (delayed response)

11
Q

2 Ways to determine origin of cushing syndrome

A
  1. 24 hour urine. high level confirms you have a lot o’ cortisol
  2. night salavary cortisol level - if it’s not low, you’ve lot control = cushings
12
Q

Determine there’s hypercortisolism. What’s the next step?

A

ACTH level
high = the disease is dependant on ACTH
low = opposite, obviosly

13
Q

Dexamethasone challenge. How’s it work, ya butt head?

A

You give dexamethasone. that should inhibit the pathway (CRH and ACTH) and lead to low cortisol.

14
Q

Test to distinguish between Cushing’s and ACTH secreting tumor

A

CRH is given.

tumors of pituitary are responsive

15
Q

Cardiovascular effects of glucocorticoids

A

positive ionotrope

increase BP

16
Q

CNS effects of glucocorticoids

A

lower seizure threshold

mood depression, anxiety, euphoria

17
Q

GI effects of glucocorticoids

A

gastric ulcers
less immune response –> h plylori
decreased Ca2+ absorption

18
Q

Treatments for Cushing Disease

A

surgery
steroid synthesis blockers - ketoconazole (also blocks ergosterol, antifungal), etomidate, metyrapone.
suppress ACTH - pasireotide (somatostatin analog), D2 analog: cabergoline
glucocorticoid receptor andtagonism - mifepristone