Adrenocorticoids Flashcards
concept: Why do you get vasoconstriction with mast cell degranulation
prevents degranulation of mast cells - - no histaomine – overal increased toen in blodo vessels - - vasoconstriction
~*~Describe the anti-inflammatory MOA of cortisol/hydrocortisone
in lecture, she said that this information ‘‘is very testable on USMLE;;
SHARK
1) inhibits phospholipase A3 (induction and activation of annexin I**) – blocks arachidonic acid release – no PGs
2) COX2 - reduced via inhibition of NfkappaB
3) INDUCES MAPK phosphatse I (inhibits MAPK activated proinflmmatory singlaing pathways)
concept: Cortisol effect mania:
@ CNS?
think cushing sydnrome presentation
insomina, euphoria –> depression
concept: Cortosial effect mania @ ICP
increased in large doses
concept: Cortisol effect mania @ pituitary hormones
suppresses ACTH - bc already too much of it around
suppresses GH - because you shouldnt be growing if you are too stressy, got other stuff to deatl with
suprresses TSH - thyroid hormones make you more crazy, dont help you relax
suppresses LH - sexy time in stressy time only sometimes a fun game
concept: How does cortisol cause peptic ulcers?
stimulation of gastric acid
suppression of immune response to H pylori
concept: affect of cortisol on blood stuff?
increases platelets and rbc and traps PMN, T cell and B cell in the blood…..why?
List the synthetic glucocorticoids please
B-D-MPT (b d empty) B- beclamethasone D - dexamethaose M - methylprednisone P - prednisone T - triamcinolone
Why is Beclamethasone special?
short t1/2
penetrats airway mucos - low systemic toxicity
Routes of Admin for synthetic glucocorticoids @ topical
BDEMT B-beclomethasone D- dexamethasone E - no M- no T- triamcinoilone and hydrocortisone BDxxT
Routes of Admin for synthetic glucocorticoids @ IM
BDMPT B - no D - no E - no M -no P - no T- triamcinolone xxxxT
Routes of Admin for synthetic glucocorticoids @ aerosol
BDMPT B - beclomethasone D - no M - no P - no T - triamcinolone BxxxT
MOA of mineralcorticoids
increased expression of a) Na/K ATPase and b) ENaC
Action of mineralcorticoids
promote Na reabsorption from renal tubule
promote K and H exretion from renal tubule
What is Fludrocortisone?
synthetic corticosteroid
** most commonly presecribed salt retaining hormone
Name the short to medium acting glucocorticoids and their anti inflam versys salt retaining ratios (just a guestimate)
HPM
hydrocortisone 1:1
prednisone 4:small
methylprednisolone 5: small
Name the intermediate acting glucocorticoids and teir anti inflamm vers salt retainining ratios (guesstimate only is okay)
triamcinolone 5:0
IM, aersol, topical
Name the long-actign glucocorticoids adn either anti inflamm vrs salt retaning ratios (guesstimate is okay)
dexamethasone 30:0
Treat Addison disease
daily hydrocortisone (short to medium with 5: low) + mineralcorticoide (fludrocortisone)
DO NOT GIVE: long acting glucocorticoids (Dexamethasone) or onces that lack salt reatining effects (Trimcinalone and dexamethasone)
rememebr: addisons has no aldosterone and cortisol so presentation = hypotension, hypoglycemia, weak, fatigue, weight loss etc
Treat acute adrenal insufficiency
parenteral hydrocortsone + correct fluid and elctrolyte abnormalities
can administer salt retaining hormone once hydrocortisone levels are reduced
Treat CAH
treat as an adrenal crsis = fluid and electroylyte replensihment and hydrocorticosterone
once stabilized –> oral hydrocortisone (5:0.25)/prednisone (4:0.3) AND fludrocortisone
Treat cushing syndrome
surgical removal of tumour, irradiation of pituitary tumor or resection of one of both adrenals
**before surgery give high dose cortisol same with after surgery - decreased dose slowly to prevent withdrawal
Treat aldosteronism/conns
spironolactone - inhibitor of mineralocorticosteroids
clinical presentation - aldosterone going crazy = sucking up too much na (water) and spitting out to much K and H
Who cares abotu teh Dexamethasone suppression test (30:0)
will suppress at high levels a pituitary dependent cushing syndrome but not an ectopic adrenal spewing out tumor
Premature infant on its way, what do you want to do?
IM steroids for mom ie dexamethasone (30:0) to help mature lungs
DOC @ hodgkin lymphona
prednisone (4:0.3)
DOC @ cerebral oedema
dexamethasone (30:0) = dont want to retain any more salt/water – or bad news bears all over the place
DOC @ idiopathic orthostatic hypotension
fludrocortisone (10:250)
A/se of synthetic corticosteroids
five million
a) metabolic effects ie cushing syndrome
b) peptic ulcer (bc stimulates gastrin and may decreased immuno vrs H pylor)
c) can mask symptoms of other diseaseas (bacterial an mycobacterial inection; keeps all the blood cells in the blood)
d) myopathy @ long acting
e) nauseua, dizzy, weight loss
f) euphoria, psychosis, depression
g) increased ICP (treat cerebral oedema with)
h) posterior subcapsular cataracts
i) sodium and fluid rentention, loss fo potassium
i) growth retardation
j) adrena suppression
What supplements to give to patient to ease a/se of peopel on corticosteroids
K
Ca
vit D
Contraindications of corticosteroids, listed from brain to toes
psychoses glaucoma heart disease/hypertenion with heart failure peptic ulcer osteoporosis TB/zoster infections diabetes
Spironolactone for who is helpful?
aldosterosim - dx and tx
hirsuitism in women - androgen antag
diuretic
A/se spironolactone
OPP OF ALDOSTERONE
= hyperkalemia (bc not spewing it out) = cardiac arrhtymia (from the hyperkalemia) = menstrual abnormalities = gynecomastia (anti androgen) sedation - i dont know headache - i dont know gi disturbances - mayeb elctrolyte and water stuffs skin rash - i dont know
MOA of mifepristone
antag @ glucocorticoid and progesterone receptor
Cxl application of mifepristone
inoperable patients with ectpic ACTH syndrome and adrenal carcinoma
How are you going to help a pateitn who has an inoperable ectopic ACTH carcinoma?
mifepristone them
= inhibits glucocorticoid receptors and progesterone receptors
Tx adrenal cancer
aminoglutethimide : blocks conversion of cholesterol to pregnenalone
and hydrocortisone or dexamethasone
MOA of ketoconazole
potent and nonselective inhibitor of adrenal and fonadal steroid synthesis
What could you treat using ketoconazole
cushing syndrome
prostate cancer
MOA of metyrapone
relatively selective inhibitor of 11 hydroxylation = cortisol and corticosterone synthehsis
Cxl app of metyrapone
tests adrenal function
PREGOS @ cushing
DOC cushing
ketoconazole
DOC cushing @ pregos
metyrapone
Metyrapone B verses R please
benefits - can be used to treat prego women cushing syndrome and test adrenal function
R: salt wand water retention, hirsutism, transient dizziness, gi disturbances = thses make no sense inmy brain. memo
salt and water = aldosterone
hirsutisim - androgens
transient dizziness
gi disturbances
:)
