Adrenal Steroids

Question 1

2 types of corticosteroids

Answer 1

Glucocorticoids
Mineralocorticoids

Question 2

Is cortisol stored or secreted when needed?

Answer 2

Secreted when needed

Question 3

Cortisol secretion is highest when?’

Answer 3

Early in the morning

Question 4

Cortisol is secreted in response to ____

Answer 4

Stress

Question 5

What hormones stimulate the release of cortisol?

Answer 5

Corticotropin releasing factor
Corticotropin (ACTH)

Question 6

Cortisol increases/decreases blood glucose

Answer 6

Increases

Question 7

Cortisol increases protein breakdown leading to:

Answer 7

Muscle atrophy
Redistribution of fat (buffalo hump, moon face)

Question 8

Cardiovascular effects of glucocorticoids

Answer 8

Increase cardiac output
Increases epinephrine vasoconstriction

Question 9

Other effects of glucocorticoids

Answer 9

Decrease body Ca2+
Increase gastric acid
Inhibit growth
Induce fetal lung surfactant
Inhibit ACTH

Question 10

Aldosterone regulated mainly by ____ system and activated by ___

Answer 10

RAAS system
Low blood volume, high potassium

Question 11

Effects of aldosterone

Answer 11

Increase sodium and water retention
Increase potassium and H+ excretion

Question 12

Disease of hypercortisolism

Answer 12

Cushing’s syndrome

Question 13

Disease of adrenal deficiency

Answer 13

Addison’s Disease

Question 14

All adrenal steroids are lipid-____ and activates ____ receptors

Answer 14

Lipid-soluble
Intracellular nuclear transcription factor receptors

Question 15

Most adrenal steroids are highly ___-bound

Answer 15

Protein-bound

Question 16

Adrenal steroids are excreted by ____

Answer 16

Kidneys/urine

Question 17

Drug name for cortisol

Answer 17

Hydrocortisone

Question 18

Prodrug of hydrocortisone

Answer 18

Cortisone

Question 19

Hydrocortisone activates which receptors?

Answer 19

Both GC and MC receptors

Question 20

Difference between prednisone and hydrocortisone

Answer 20

Prednisone has slower metabolism so is more potent
Prednisone is partially selective for GC vs MC receptors (better for inflammation)

Question 21

Hydrocortisone is usually used for ____ and not for ____

Answer 21

Endocrine replacement
Not for inflammation

Question 22

Dexamethasone is highly __ selective

Answer 22

GC

Question 23

When is dexamethasone used?

Answer 23

Very severe inflammation

Question 24

Fludrocortisone has increased ___ potency

Answer 24

MC (still strong GC potentcy)

Question 25

Fludrocortisone is used to replace what hormone?

Answer 25

Aldosterone

Question 26

Spironolactone is a MC _____

Answer 26

Antagonist

Question 27

What is spironolactone used for/as?

Answer 27

K+ sparing diuretic

Question 28

Why are some steroids administered locally?

Answer 28

Avoid systemic toxicity/effects

Question 29

Glucocorticoids are the most powerful anti-inflammatory drugs but are not 1st line. Why?

Answer 29

Toxicity Lots of systemic effects

Question 30

How do glucocorticoids decrease inflammation?

Answer 30

Decrease redness and swelling (vasoconstriction and decrease histamine release) Decrease fever/heat and pain (inhibit arachadonic acid metabolism, decrease prostaglandins, and decrease COX2 expression)

Question 31

Diseases treated by glucocorticoids

Answer 31

RA Dermatitis Lupus Allergic reactions Asthma

Question 32

Adverse effects of glucocorticoids

Answer 32

Hypernatremia Hypokalemia Edema Hypertension Alkalosis Muscle wasting Weight gain Cataracts Peptic ulcer Osteoporosis Increased risk of infection/immunosuppression

Question 33

Safe ways to administer corticosteroids

Answer 33

Short term high dose Long term low dose (Use lowest dose for shortest time possible)

Question 34

Glucocorticoids usually do/don’t treat underlying disease

Answer 34

Don’t treat underlying disease, help with pain and further tissue damage