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Pharm: block 2 week 1 > Adrenal Steroids > Flashcards

Adrenal Steroids Flashcards

1
Q

Steriods are synthesized when…..

A

Not stored - synthesized when needed - rate of secretion equals rate of synthesis

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2
Q

________ - cholesterol → pregnenolone → desoxycorticosterone → aldosterone

A

Zona glomerulosa

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3
Q

___________ – cholesterol → pregnenolone → desoxycortisol → cortisol

A

Zona fasciculata and reticularis

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4
Q

Synthesis of cortisol controlled by

A

adrenocorticotropic hormone (ACTH).

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5
Q

What controls the synthesis of Aldosterone?

A

angiotensin II and plasma potassium.

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6
Q

90% of steroids are bound in plasma to

A

corticosteroid binding globulin (CBG or transcortin) and albumin

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7
Q

3 Ways steroids are inactivated by liver

A

Reduction of A ring
Sulfate conjugation
Glucuronide conjugation

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8
Q

Structures necessary for activity include

A

4,5-double bond, 3-ketone, 11-hydroxyl, 17-hydroxyl, 21-hydroxyl.

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9
Q

A ______ and _______ increase glucocorticoid activity and reduce mineralo- corticoid activity.

A

1,2-double bond

16- substitution

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10
Q

How do glucocorticoids cause an effect in target tissues?

A

Binds to cytosolic steroid R–>Translocated to nucleus –>Stimulates transcription of mRNA–>Stimulates mRNA directed protein synthesis–>Proteins mediate glucocorticoid effect

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11
Q

What mediates Carb and protein metabolism?

A

Mediated by Glucocorticoid receptor

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12
Q

Glucocorticoids have what effect on liver gluconeogensis?

A

Enhances liver gluconeogenesis from protein

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13
Q

Glucocorticoids have what effect on aa’s?

A

Stimulates amino acid mobilization (skeletal muscle, skin, etc.)

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14
Q

Glucocorticoids _____ plasma glucose and ______ liver glycogen

A

increases plasma glucose

Increases liver glycogen

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15
Q

What happens to urine when on glucocorticoids?

A

Increases urinary nitrogen excretion

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16
Q

Glucocorticoids will _____ peripheral glucose utilization

A

Reduces peripheral glucose utilization

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17
Q

What affects to we see on Lipid metabolism as a result of using Glucocorticoids?

A

Redistribution of body fat - moon face, buffalo hump

Stimulates release of fatty acids from adipose tissue

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18
Q

What effects does cortisol have in the kidney?

A

Not much because most cortisol is converted to cortisone via 11B hydroxysteroid DH so we see predominately mineralcorticoid effects

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19
Q

Mineralcorticoids have what effects in the kidney

A

Increases sodium reabsorption
Increases potassium and hydrogen ion excretion
–>Responsible for cardiovascular effects - hypertension

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20
Q

How are mineralcorticoids responsible for hypertension in CV system?

A

Increases sodium reabsorption

Increases potassium and hydrogen ion excretion

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21
Q

CNS affects of corticosteroids on CNS

A

sleepiness, lability of mood

22
Q

How do Glucocorticoids cause Lymphocytopenia and monocytopenia

A

redistribution of cells out of vascular space

23
Q

By redistributing lympocytes and monocytes out of vascular space Glucocorticoids will….

A

reduce access of cells to target tissue

24
Q

Glucocorticoids will_______ neutrophil adherence to endothelium
________ action of chemotactic factors

A

Prevent

Inhibit

25
What 3 effects do glucocorticoids have on macrophages?
Inhibits antigen processing Inhibit binding to Fc receptors Inhibit synthesis and release of IL-1
26
By interering with macrophage antigen processing, glucocorticoids will inhibit activiation of
T cells
27
REduction of ____ prevents auto-activation of T cells (strategy of glucocorticoids)
IL-2
28
What are some of the T cell functions that steroids inhibit
macrophage migration inhibitory factor, macrophage aggregating factor, monocyte chemotactic factor and lymphotoxin
29
Absence of _____ prevents activation of T cell (d/t steroids)
IL-1
30
When TNF binds to it's receptor REC it leads to destruction of
IkB
31
IkB is attached to ______ until IkB is destroyed when TNF binds to it's receptor
NFkB
32
NFkB will enter nucleus and....
stimulate production of pro-inflammatory cytokines
33
How do glucocorticoids reduce the expression of cytokines
GC's will bind to their REC --> go into the nucleus and upregulate transcription of IkBa so it tightly adheres in inhibits NK-kB from upregulating cytokine transcription
34
GCs will increase production of ______ to block NFkB transcription of cytokines
IkBa
35
How do GCs reduce the production of PGs and LKs?
Inhibits arachidonic acid release so synthesis of prostaglandins and leukotrienes is reduced.
36
By inhibiting cytokines, GCs will also decrease induction of this enZ
COX2
37
GCs will _______ capillary permeability
decrease
38
When do we need to be careful of GC use? Are we worried about GC side effects with single dose?
A single dose is usually without harmful effects. Prolonged therapy has lethal potential.
39
GCs are used curatively or sypmtomatically
used to tx symptoms, not cure an illness
40
Abrupt discontinuation of GCs may be life-threatening due to
adrenal insufficiency
41
What adrenal situation would GCs be a good use for?
Adrenal insufficiency - steroid replacement therapy
42
GCs can be used in RA, but only in _______ and in combination with:
Rheumatoid arthritis - use only in progressive disease in combination with salicylates, gold salts, and physical therapy.
43
GCs used in osteoarthritis how?
given into joint for acute inflammation.
44
GC's can be used for these allergic diseases:
hay fever, serum sickness, drug reaction, anaphylaxis, bronchial asthma
45
how should we use GCs when tx inflammation of eye, ears, skin?
locally
46
can GCs be used to tx cerebral edema?
yes bc they cross the BBB
47
What are some misc. diseases GCs can be used for
organ transplantation, thrombocytopenia, liver diseases, collagen diseases, renal diseases
48
What are the contraindications of GC use?
pts with exsisting infections or if they have TB
49
What do we see with GC toxicity?
Rapid withdrawal - Acute adrenal insufficiency occurs. Salt wasting and cardiovascular collapse
50
Symptoms of Cushings syndrome
1) Moon face and Buffalo hump. 2) Poor wound healing. 3) Thin skin. 4) Hypertension. 5) Thin extremities. 6) Striae
51
If we have prolongued GC therapy for more than 2 weeks at high doses, what do we worry about? how do we handle taking patient off the drugs?
Suppression of pituitary - adrenal function may last longer then 12 monts SLOOwly wean pts off GCS

Pharm: block 2 week 1 (4 decks)

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