Wednesday - Adrenal Pharm - Trachte Flashcards Preview

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

What do you use glucocorticoids for? (as treatment)

immune suppressants
vascular disorders
renal disorders
organ transplant
allergies
so many things

2

How do glucocorticoids have anti-inflammatory effects

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

3

How are glucocorticoids anti-allergic

block production of histamine and effects of histamine receptor!

4

how are synthetic glucocorticoids more potent than cortisol?

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

5

which glucocorticoid has a lot of mineralcorticoid activity?

fludrocotisone

6

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

cushing syndrome

7

Glucocorticoid effects on white blood cells

lymphocytes decrease
neutrophils actually increase (because you block extravasation into tissue)

8

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

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

9

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

short ACTH (tetracosactide) test

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

10

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

In addison's, cortisol level would be low always

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

11

2 Ways to determine origin of cushing syndrome

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

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

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

13

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

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

14

Test to distinguish between Cushing's and ACTH secreting tumor

CRH is given.
tumors of pituitary are responsive

15

Cardiovascular effects of glucocorticoids

positive ionotrope
increase BP

16

CNS effects of glucocorticoids

lower seizure threshold
mood depression, anxiety, euphoria

17

GI effects of glucocorticoids

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

18

Treatments for Cushing Disease

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