adrenal pharamchology Flashcards
The medulla secretes _________, whereas the cortex secretes_____________&________&__________.
.
catecholamines
glucocorticoids, mineralocorticoids and adrenal androgens
The outer zona glomerulosa: Produces mainly
.
mineralocorticoids (aldosterone)
mineralocorticoids (aldosterone) regulate
salt and water metabolism.
Production of aldosterone is regulated primarily by
the renin–angiotensin system.
The middle zona fasciculata produce mainly
Glucocorticoids (cortisol)
glucocorticoids (cortisol)
Involved with metabolism and response to stress.
The inner zona reticularis secretes
adrenal androgens
The inner zona reticularis is controlled by
ACTH
ACTH is released in response to hypothalamic ________
CRH.
Glucocorticoids serve as feedback inhibitors of ____&____
ACTH and
CRH secretion
Glucocorticoids can be administered:
IM, SC, topical (skin, ophthalmic,
otic, rectal..etc), inhalation, oral .
Glucocorticoid agents with the__________ half-life tend to be the_______:
longest, most potent
Short-acting agents (GLUCOCORTICOID Agents) example & how long of acting
cortisol are active for 1–12 hours
Intermediate-acting agents (GLUCOCORTICOID Agents) example & how long of acting
prednisolone are active for 12–36 hours
Long-acting agents (GLUCOCORTICOID Agents) example & how long of acting
dexamethasone are active for 36–55 hours
relations between duration and potency to anti-inflammatory effect and mineralocorticoids
if duration increase the potency increase to inflammatory effect but decrease to mineralocorticoid effect
the more potent drug need _______ to achieve the same effect of the lower potent drug
low dose
the different ways to administrated the same drug can affect the potency of drug ,how ?
for example, dexamethasone is very potent if we take it orally but if we take it topically it will lose it is potency
how do we take corticosteroid drug?
1-Drug administration attempts to pattern the circadian rhythm: A double
the dose is given in the morning, and a single dose is given in the afternoon
2-Alternate-day therapy
3- even stopping the drug that has long-acting should not be abruptly
Alternate-day therapy to corticosteroid is necessary why ?
causing less severe suppression of the adrenal-hypothalamic-
pituitary axis.
physiological effect of glucocorticoids in ( proteins ,glucose ,amino acids ,fatty acids ,ketons body ,Na,water ,kaluresis ,bones(ca++),
increase to all except to ca++ it will Decrease intestinal absorption of calcium and inhibit osteoblasts
Physiologic effects of Glucocorticoids Anti-inflammatory effects:
Inhibits all of the classic signs of inflammation (erythema, swelling,
pain, and heat).
Anti-inflammatory specific effects includes
- Inhibition of the antigenic response of macrophages and leukocytes
- Inhibition of vascular permeability by reduction of histamine release
- Glucocorticoids decrease circulating WBC
• Long-term therapy results in the inhibition of plasma ACTH and
involution and atrophy of all lymphoid tissues
• Inhibition of cytokine production, including IL-1, IL-2, IL-3, IL-6,
tumor necrosis factor-α, and granulocyte-macrophage colony-
stimulating factor
• Inhibition of arachidonic acid and prostaglandin production by
inhibition of phospholipase A2 and the cyclooxygenases
inhibition of phospholipase A2 and the cyclooxygenases by what ?
phospholipase A2 : anti-inflammatory glucocorticoids
cyclooxygenases Aspirin ,indomethacin ,ibuprofen
physiological effect of glucocorticoids in (fibroblasts ,acid and pepsin ,CNS ,Surfactant )
– Inhibition of fibroblast growth and collagen synthesis
– Stimulation of acid and pepsin secretion in the stomach
– Altered CNS responses, influencing mood and sleep patterns
– Induction of surfactant production in the fetal lung at term
Therapeutic effects of Glucocorticoids
(replacement therapy )primary or secondary insufficiency
(Addison disease);
Inflammation and immunosuppression
Dermatologic disorders: Eczema, Psoriasis..etc
Idiopathic nephrosis of children
Neuromuscular disorders, such as Bell’s palsy
Shock
Adrenocortical hyperplasia
Stimulation of surfactant production and acceleration of lung maturation
in a preterm fetus
Diagnosis of Cushing syndrome: (dexamethasone suppression test)
Neoplastic diseases, including adult and childhood leukemias
Inflammation and immunosuppression examples in Glucocorticoids
Autoimmune diseases
Hypersensitivity and allergic reactions
Organ or graft rejection
Diagnosis of Cushing syndrome: (dexamethasone suppression test) how?
give the patient Dexamethasone for negative feedback then measures the level of cortisol
if it is lower than before it is secondary
if it is still high the problem is in the adrenal so it is primary or ectopic tumor release ACTH
Adverse effects of glucocorticoids
Sodium retention ,Potassium loss (hypokalemia),Adrenal suppression
Hyperglycemia and steroid-induced diabetes mellitus , Weight gain
Osteoporosis , Peptic ulcer
Cataracts
and increased intraocular pressure lead to glaucoma
- Edema
- Hypertension
- Increased susceptibility to infection and poor wound healing
- Muscle weakness and tissue loss
Mineralocorticoids Drug examples
Fludrocortisone
The adverse effect of mineralocorticoids
Include sodium retention and hypokalemia, edema, and hypertension
Drugs for obesity are considered effective if they demonstrate at least a
___ greater reduction in body weight as compared to placebo
5%
Drugs for obesity example
Lipase inhibitor (Orlistat)
Mechanism of action: Orlistat
inhibits gastric and pancreatic lipases, thus
decreasing the breakdown of dietary fat about 30%
It has minimal systemic absorption and is mainly excreted in the feces.
Orlistat
Adverse effects of Orlistat
GIT symptoms (most common ): oily spotting, flatulence, fecal urgency, and increased defecation. Orlistat interferes with the absorption of fat-soluble vitamins and β-carotene.
Adverse effects of Orlistat
GIT symptoms (most common ): oily spotting, flatulence, fecal urgency, and increased defecation.
adverse effects of orlistat may be minimized through __________&_________
a low-fat diet and the use of
concomitant cholestyramine.
Orlistat is contraindicated in
in pregnancy and in patients with chronic
malabsorption syndrome or cholestasis.
person who take orlistat should be adviced to take _____________ & the time for take it _________
take supplements of vitamins A, D, E, and K and
also β-carotene
should not be taken within 2 hours of orlistat
Angiotensin II is a major stimulus for the production of which steroid hormone(s)?
a. Aldosterone.
b. Hydrocortisone.
c. Glucocorticoids.
d. Testosterone.
a
Which endocrine gland synthesizes and secretes corticosteroids?
a. Thyroid.
b. Adrenal.
c. Pituitary.
d. Pancreas.
B
Which is NOT a result of corticosteroid deficiency?
a. Na+ retention.
b. Hyperkalemia.
c. Cellular hydration.
d. Extracellular fluid reduction.
A
Which is NOT involved with the anti-inflammatory effect of glucocorticoids?
a. Increased release of histamine.
b. Decreased production of cyclooxygenase.
c. Increased inhibition of white blood cell production.
d. Decreased production of prostaglandins and leukotrienes.
A
Which therapeutic effect do glucocorticoids have on rheumatoid arthritis (RA)?
a. Stop the destruction of joints.
b. Relieve pain and inflammation.
c. Repair the destruction of joints.
d. Boost the immune system to fight joint destruction.
B
Glucocorticoids only provide symptomatic relief from joint pain and inflammation in the joints affected by rheumatoid arthritis; unfortunately, the joint destruction
continues.
Glucocorticoids are NOT recommended for which case?
a. Oral ulcerations.
b. Pulpal hypersensitivity.
c. Temporomandibular joint disorder.
d. Oral surgery complications.
B
The natural daily production of cortisol peaks generally at which time of day?
a. 8:00 a.m.
b. 12:00 p.m.
c. 8:00 p.m.
d. 12:00 a.m.
A
Which glucocorticoid is short-acting?
a. Prednisolone.
b. Hydrocortisone.
c. Dexamethasone.
d. Methylprednisolone
B
Which glucocorticoid is short-acting?
a. Prednisolone.
b. Cortisol.
c. Dexamethasone.
d. Methylprednisolone.
b
Which is NOT a dental consideration for long-term glucocorticoid therapy?
a. Delay wound healing.
b. Potential adrenal crisis.
c. Increased abdominal fat.
d. Lower resistance to infection.
c
. Select an endocrine drug which is a steroidal derivative:
a) Gonadorelin
b) Insulin
c) Levothyroxine
d) Hydrocortisone
d
