adrenocorticosteroids Flashcards
mifepristone
gluocorticoid antagonist
spirnolactone
mineralcorticoid antagonist
ketoconazole
corticosteroid synthesis inhibitor
aminoglutehimide
corticosteroid synthesis inhibitor
metyrapone
corticosteroid synthesis inhibitor
fludrocortisone
mineralcorticoid agonist
major effects of cortisol
1) gluconeogenesis and 2) glycogen synthesis = maintains hepatic glycogen in fasting state
- - inc glucose levels
stimulate lipolysis
stimulate protein catabolism
net = maintain adequate glucose to brain
catabolic effects = wasting to lymphoid, CT, muscle, fat, skin, osteoporosis, growth retardation
immunosuppressive =
- inc neutrophils (inc influx and dec migration form BV)
- dec lymphocytes, monocytes, eosinophils, basophils
- vasoconstriction - d/t mast cell degranulation
anti-inflamm
- inhibit PLA2 - blocking arachidonic acid, COX2
- induction of MAPK-phosphatase 1
CNS: behavioral changes - insomnia/euphoria
Inc ICP
Suppress ACTH, growth hormone, TSH, LH
Peptic ulcers (stimulate gastric acid and suppress immune response to h. pylori)
- Inc platelets, RBC
- renal function is impaired with cortisol deficiency
- develop fetal lungs
which glucocorticoid has a short t 1/2
beclomethasone
- penetrates airway mucosa
which glucocorticoid can be given IM
triamcinolone
which 2 glucocorticoids can be given with aerosol
beclomethasone
triamcinolone
good for asthma, or pt that you don’t want to systemic effects
which glucocorticoids can be given systemic
beclomethasone
dexamethasone
hydrocortisone
triamcinolone
mineralocorticoids MOA
inc expression of Na/K ATPase and ENaC
- promote Na reabsorption from renal tubule
- promote K and H excretion
short to medium acting glucocorticoids
hydrocortisone
prednisone
methylprednisolone
intermediate acting glucocorticoid
traimcinolone
long acting glucocorticoid
dexamethasone
which glucocorticoid has 1:1 anti inflamm to salt retaining
hyrocortisone
which glucocorticoids has 0 salt retaining effects
triamcinolone
dexamethasone
these wouldn’t be good for addison’s (loss of both gluoccorticoid and mineracorticoid)
treat addison’s
daily hydrocortisone (increase before stress) + mineralocorticoid (fludrocortisone)
don’t give glucocorticoids lacking salt retaining effects**
tx ACUTE adrenocortical insufficiency
large amoutns of parenteral hydrocortisone + correction of fluid, electroyltes
can give fludrocortisone once hydrocortisone levels are reduced
tx congenital adrenal hyperplasia
intially: treat like acute adnreal crisis
once stabilized = oral hydrocortisone/prednisone + fludrocortisone
tx cushings syndrome
remove tumor
radiation
resection of both adrenals
tx with high doses of cortisol before and after surgery - slowly decrease to prevent withdrawal
tx alodsteronism
spirnolactone
lung maturation in fetus
IM dexamethasone
hodgkins lymphoma tx
prednisone
cerebral edema tx
dexamethasone
idiopathic orthostatic hypotension tx
fludrocortisone
corticosteroid AE
metabolic - cushingoid, DM, osteoporosis peptic ulcers infections myopathy (long term) CNS - euphoria increased IOP subcapsular cataracts growth retardation adrenal suppresion
**abrupt withdrawal can cause adrenal insufficiency
corticosteroid contraindication
peptic ulcers HTN, HF TB, zoster infection psychoses DM osteoporosis glaucoma
spirnolactone
competitive antagonist = decreases effect peripherally
use = aldosteronism, hirsutism, diuretic
spirnolactone AE
hyperkalemia
cardiac arrythmias
gynecomastia
rash
mifepristone use
inoperable pt with ectopic ACTH syndrome or adrenal carcinoma
aminogluthethimide
corticosteroid synthesis inhibitor
block conversion of cholesterol to preneolone = reduce synthesis of all hormonally active steroids
aminoglutethimide use
adrenal cancer (+ hydrocortisone/dexamethasone)
ketoconazole use
cushing’s syndrome
prostate cancer
metyrapone
selective inhibitor of steroid 11 hydroxylation = interferes with cortisol and corticosterone synthesis
metryapone use
tests adrenal function
tx pregnant women with cushing’s
tx pregnant female with cushing
metyrapone
metyrapone AE
salt and water retention
hirsutism
transient dizziness
GI disturbances
