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Y2S1-Pharmacology > ACTH and steroid hormones > Flashcards

ACTH and steroid hormones Flashcards

1
Q

Dr Mohammad Saleh said mechanism of action, extremely important side effects and contraindications are what you should focus on for all his lectures.

A
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2
Q

What compound is the precursor for all adrenal hormones?

A

Pregnolones

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3
Q

ask the doctor which corticosteroid drugs should we memorize

A
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4
Q

What is an example of a mineralocorticoid drug?

A

Fludrocortisone

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5
Q

What is the use of fludrocortisone?

A

Used as a replacement therapy in Addison’s disease, replacing aldosterone in patients with primary adrenal insufficiency (Addison)

  • Flud → fluid → aldosterone increases ECF know sth like that
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6
Q

When is fludrocortisone used?

A

In addison

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7
Q

What are the different uses of glucocorticoids?

A

Inflammation, allergy, autoimmune, and others

  • Administered orally, parenterally, inhaled, or topical
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8
Q

What are the different classifications of glucocorticoids?

A

1) Low-potency, short-acting glucocorticoid

2) Medium-potency, intermediate-acting glucocorticoid

3) High-potency, long-acting glucocorticoid

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9
Q

What are the low-potency short-acting glucocorticoid drugs?

A

1) Hydrocortisone (pharmaceutical cortisol)

2) Cortisone

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10
Q

What is the use of the low-potency, short-acting glucocorticoid?

A
  • Cortisone is rapidly metabolized to hydrocortisone by the liver after an oral administration

Hydrocortisone and cortisone are the preferred glucocorticoids when replacing them in adrenal insufficiency, they are used as anti-inflammatory, allergy, and autoimmune disorders

  • In hepatic failure /dysfunction patients u should use cortisol , because cortisone “prodrug” need to be metabolized in the liver first
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11
Q

What are the uses of hydrocortisone and cortisone?

A

1) Replacement therapy

2) Inflammation

3) Allergy

4) Autoimmune disorders

  • Can be used in emergency situation as an IV
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12
Q

What are the medium-potency (intermediate-acting) glucocorticoids?

A

1) Prednisone (prednisone is rapidly converted to prednisolone)

2) Prednisolone

3) Methylprednisolone

4) Triamcinolone

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13
Q

When are medium-potency glucocorticoids used?

A
  • Most often for systemic treatment
  • Their duration of action is 12-36 hours

1) Cancer

2) Inflammation

3) Allergy

4) Autoimmune disorders

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14
Q

What are the different high-potency glucocorticoids?

A

1) Betamethasone

2) Dexamethasone

3) Budesonide (inhaled)

  • You inhale the fragrance of flower buds (budesonide is administered via inhalation)
  • Dexnostic and diagnostic sound similar (dexamethasone is used for a diagnostic test)
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15
Q

When is betamethasone used?

A
  • Systemic use

Topical use for skin disorders:

1) Psoriasis

2) Atopic dermatitis

3) Neurodermatitis

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16
Q

When is dexamethasone used?

A

1) Diagnostic dexamethasone for suppression tests

2) Neoplastic, infectious and other inflammatory conditions

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17
Q

Which drug is used in systemic lupus erythematosus?

A

Prednisone

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18
Q

Which drugs are used in multiple sclerosis?

A

1) Prednisone

2) Methyprednisolone

3) Dexamethasone

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19
Q

Which drugs are used in ulcerative colitis?

A

1) Methylprednisolone

2) Budesonide

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20
Q

Which drugs are available for nasal/oral inhalation to treat allergic rhinitis/asthma?

A

1) Beclomethasone

2) Mometasone

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21
Q

What is ciclesonide indicated for?

A

Fever/allergic rhinits

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22
Q

In what type of cancer is glucocorticoids used?

A

1) Lymphocytic leukemias

2) Lymphoma

  • Dexamethasone can prevent emesis during chemotherapy (prevents vomiting)
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23
Q

Which glucocorticoid is used for respiratory distress syndrome in premature infants?

A

Betamethasone (promotes lung maturation as cortisol does)

  • Treats RDS in premature infants
  • Glucocorticoid isn’t recommended for pregnant ladies, however, it is given to the pregnant woman for 3 days before delivery if neonatal respiratory distress syndrome is suspected (as the drug is highly lipophilic and can cross the placental barrier)
  • Betamethasone prevents NRDS in Bremature Babies
24
Q

Which drug is used in primary adrenal insufficiency (addison)?

A

Fludrocortisone and hydrocortisone

  • all regions of the adrenal cortex are destroyed. This gives rise to deficiencies in cortisol and aldosterone and to a reduction in androgen secretion
25
Q

Which drug is used in secondary adrenal insufficiency?

A

Hydrocortisone (glucocorticoid only)

  • Most commonly results when steroid drugs are used for a prolonged time, thereby suppressing the hypothalamic-pituitary-adrenal axis. Secondary disease is characterized by low levels of cortisol and androgens but normal levels of aldosterone
26
Q

What is an acute adrenal insufficiency?

A
  • AKA adrenal crisis/addisonian crisis
  • It is a medical emergency that must be treated with IV hydrocortisone for up to 48 hours
27
Q

What is the treatment for an acute adrenal insufficiency?

A

IV hydrocortisone

28
Q

How to treat chronic adrenal insufficiency?

A

Oral hydrocortisone in a way that mimics the circadian rhythm (2/3 of the dose in the morning and 1/3 in the evening)

29
Q

What is meant by congenital adrenal hyperplasia?

A

They are a group of disorders that are caused by specific enzyme deficiencies (most commonly 21a-hydroxylase) which impair the synthesis of cortisol and aldosterone, leading to a compensatory mechanism by which the pituitary gland will secrete more ACTH ,and thus the adrenal gland will hyperplasia

  • In this condition the biosynthesis of the hormone will shift to the production of androgens, resulting in masculinization and pseudo-hermaphroditism in girls
30
Q

What is the treatment for congenital adrenal hyperplasia (CAH)?

A

1) Hydrocortisone

2) Fludrocortisone

31
Q

How to diagnose cushing?

A

1) Free cortisol level in urine samples

2) Testing with dexamethasone

32
Q

How to treat Cushing’s syndrome?

A

1) Surgical excision of the pituitary adenoma/hyperplastic adrenal glands

2) Large dosage of hydrocortisone parenterally during the surgical procedure

33
Q

In treating dermatologic conditions to what skin area are the low-potency drugs applied?

A
  • Thinner skin (like the face and eyes)
34
Q

In treating dermatologic conditions to what skin area are the low/medium-potency drugs applied?

A

1) Ears

2) Trunk

3) Legs

4) Scalp

35
Q

In treating dermatologic conditions to what skin area are the med/very high-potency drugs applied?

A
  • Thicker skin (palms and soles)
36
Q

What are the low-potency topical steroids?

A

1) Hydrocortisone

2) Desonide

  • Low: Hydrate under de sun
37
Q

What are the very highly potent steroids?

A

1) Betamethasone

2) Dexamethasone

38
Q

Which corticosteroid can be applied to the face?

A

Low-potency ones:

1) Hydrocortisone

2) Desonide

  • Do not ever use very high potency in the face
39
Q

What are some of the other disorders that are treated by glucocorticoids?

A

1) Hypercalcemia

2) Sarcoidosis

3) Used as immunosuppressants (to prevent graft rejection)

40
Q

What are the side effects of long-term use of glucocorticoids?

A
  • Same Same cushings symptoms
  • Buffalo hump, hair thinning, glaucoma, striae, bruising, decreased skin thickness, hyperglycemia, menstrual disturbances, peptic ulcer, etc
41
Q

Do we have adrenal androgen replacements?

A

Their drug isn’t strong enough to replace androgens in the case of insufficiency

just give testosterone directly if necessary

42
Q

What are the drugs that inhibit the synthesis of corticosteroids?

A

1) Aminoglutethimide

2) Metyrapone

3) Ketoconazole

4) Fluconazole

43
Q

What drugs are corticosteroid receptor antagonists?

A

1) Spironolactone

2) Mifepristone

44
Q

What is the mechanism of action of aminoglutethimide?

A

It inhibits the conversion of cholesterol to pregnenolone “the precursor of all adrenal hormones” (early/rate-limiting step in adrenal steroid biosynthesis)

45
Q

When is aminoglutethimide used?

A

1) Breast cancer and malignant adrenocortical tumors (as all steroidal synthesis is reduced by it)

2) It is added to metyrapone to treat Cushing

46
Q

What is the mechanism of action of metyrapone?

A

Inhibits the synthesis of glucocorticoids by inhibiting 11b-hydroxylase enzyme (catalyzes the final step in the glucocorticoid pathway)

  • It usually shifts the pathway to the production of adrenal androgens
47
Q

When is metyrapone used?

A

It is added in combination to aminoglutethimide to treat cushing

48
Q

What is the mechanism of action of ketoconazole and fluconazole?

A
  • They are antifungal drugs that inhibit several cytochrome P450 enzymes involved in the steroid biosynthesis
  • They also inhibit the synthesis of androgens
49
Q

What are the uses of ketoconazole and fluconazole?

A

1) Cushing (they can lower cortisol to the normal range)

  • I got a fungal infection but thought it was the flu so i went on a keto diet for P 450 days and now i feel less manly (gynecomastia and inhibiting androgens)
50
Q

What are the side effects of ketoconazole and fluconazole?

A

Gynecomastia in males

51
Q

What is the mechanism of action of spironolactone?

A

It competes with aldosterone for its receptor in the renal tubule

52
Q

What are the uses of spironolactone?

A

1) Hyperaldosteronism (Potassium sparring diuretic used)

2) Improves secondary hyperaldosteronism which is associated with heart failure, batter syndrome, and other conditions

  • The primary choice for primary hyperaldosteronism due to bilateral adrenal hyperplasia
  • In aldosterone-producing adenomas, surgery is the treatment of choice
53
Q

What is the mechanism of action of mifepristone?

A

Antagonist for both progesterone and glucocorticoid receptors

( Mafi progesterone + glucocorticoid “hahahahah”)

54
Q

When is mifepristone used?

A

In Cushing’s syndrome

55
Q

What are the drugs that can be used for crushing syndrome?

A

1) Mifepristone

2) Ketoconazole and Fluconazole

3) Metyrapone + Aminoglutethimide

4) Large parenteral dosage of hydrocortisone in case of surgery to remove hyperplastic adrenal glands

Y2S1-Pharmacology (13 decks)

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