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MOD 1 Quiz 1 > Adrenocoticosteroids and Adrenocortical Antagonists > Flashcards

Adrenocoticosteroids and Adrenocortical Antagonists Flashcards

1
Q

Use of adrenocortical steroids?

A

diagnosis and treatment of disorders of adrenal function, treatment of variety of inflammatory and immunologic disorders

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2
Q

Control secretion of adrenocortical steroids?

A

pituitary release of corticotropin ACTH

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3
Q

Control secretion of aldosterone?

A

angiotensin

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4
Q

Physiologic effects of cortisol?

A

regulation of intermediary metabolism, cardiocascular function, growth, immunity

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5
Q

Pattern of cortisol secretion?

A

circadian, pulses peak early morning hours and after meals

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6
Q

Cortisol is bound to what in plasma?

A

corticosteroid binding globulin

small amount is free or bound to albumin

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7
Q

When is CBG increased?

A

pregnancy, esterogen admin, hyperthyroidsim

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8
Q

When is CBG decreased?

A

hypothyroidism, genetic defects in synthesis, and protein def

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9
Q

Synthetic corticosteroids largely bind to?

A

albumin

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10
Q

When is half life of cortisol increased?

A

hydrocortisone admin in large amt, stress, hypothyroidism, liver disease

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11
Q

Glucocorticoids mediate their effect through?

A

glucocorticoid receptors (nuclear receptors)

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12
Q

in abscence of hormone, what do glucocorticoid receptors do?

A

cytoplasmic, in oligomeric complexes with heat shock proteins

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13
Q

Most important heat shock protein for glucocorticoid receptors?

A

HSP90

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14
Q

GRE?

A

glucocorticoid receptor elements
what the receptor-ligand complex binds to (after hormone binds to glucocorticoid receptor the receptor and the hormone then move into the nucleus and bind to this)

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15
Q

When the receptor is bound to heat shock protein is it activated/ inactived?

A

inactivated

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16
Q

How does glucocorticoids stimulate gluconeogeneisis or glycogen synthesis in the fasting state?

A

stimulate phosphoenolpyruvate carboxylase, glucose-6 phosphate, glycogen synthase

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17
Q

How does glucocorticoids inhibit inflammation?

A

inflammation is extraversion and inflitration of leukocytes into the affected tissue, glucocorticoids inhibit the white cell adhesions with endothelial cells

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18
Q

glucocorticoids effect on macrophages?

A

limit ability to phagocytose and kill micoorganisms and to produce tumor necrosis factor alpha, interleukin 1, metalloproteinases, plasminogen activator

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19
Q

How else do glucocorticoids affect inflammation?

A

reduce prostaglandins, leukotriene, platelet activating factor synthesis that results from phospholipase A2

reduce expression of cyclooxygenase 2

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20
Q

Short toe medium acting glucocorticoids?

A 
Hydrocortisone
Cortisone
Prednisone
Prednisolone
Methylprednisolone
Meprednisone
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21
Q

Intermediate acting glucocorticoids?

A

Triamcinolone
Paramethasone
Fluprednisolone

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22
Q

Long acting glucocorticoids?

A

Betamethasone

Dexamethasone

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23
Q

Mineralcorticoids?

A

Fludrocortisone

Desoxycorticocosterone acetate

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24
Q

Treatment for Chronic Adrenocortical insufficiency (Addison’s disease)?

A

Hydrocortisone given daily, increased amounts during stress
supplemented with fludrocortisone (salt retaining)

long acting not administered

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25
Treatment for acute Adrenocortical insufficiecny?
large amount of parenteral hydrocortisone in addition to correction of fluid and electrolyte abnormalities (sodium succinate or phosphate)
26
Treatment for Congenital Adrenal hyperplasia?
may be in acute adrenal crisis, treat as such (large amount of parenteral hydrocortisone in addition to correction of fluid and electrolyte abnormalities (sodium succinate or phosphate)) once stable, oral hydrocortisone is given alternate day therapy with prednisone (greater ACTH supression with out growth inhibition) Fludrocorsine should be administered by mouth
27
Treatment for Cushing's syndrome?
surgical removal of the tumor producing ACTH or cortisol, irradiation of pituitary tumor, resection of one or both adrenals large dose of cortisol during and after surgery
28
Primary aldosteronism?
excessive production of aldosterone by an adrenal adenoma
29
Treatment for primary aldosteronism?
Not with fludrocortisone (patients fail to retain sodium and secretion not reduced) With spironolactone
30
Glucocorticoids use for diagnosis?
dexamethasone is used because use of small quantities reduces the possibility of confusion in interpretation
31
dexamthasone suppression test
diagnosis of Cushing's syndrome give dexamethasone in evening and measure in morning, Cushing patient with have a high level (over 5 mcg/dl)
32
distinguish hypercortisolism due to anxiety, depression, and alcoholsim and Cushing's?
combined test consisting of dexamethasone followed by standard corticotropin release hormone test
33
Distinguish a patient with Cushing from steroid producing tumors?
large dose of dexamethasone should produce a 50 % reduction in hormone ACTH low in cortisol producing adrenal tumor and elevated in ectopic ACTH producing tumor
34
What type of synthetic glucocorticoids are better?
medium to intermediate acting, keep dose low
35
Should therapy be stopped abruptly/ decreased?
no cxr and tuberculin test for TB ck for diabestes, peptic ulcer, osteoporosis, and pysch disturbance
36
Cushing's syndrome?
need for insulin, weight gain, myopathy, thinning of skin, osteoporosis, diabetes, aseptic necrosis of hip
37
Long term effects of glucocorticoids?
hypokalemic, hypochlorinc alkalosis, rise in BP
38
If dosage is reduced too rapidly?
anorexia, nausea, vomit, weight loss, lethargy, headache, fever, joint or muscle pain, postural hypotension
39
Alternative day administration?
works because you allow recovery period between each dose, allowing large doses to be given
40
treat severe autoimmune?
prednisone
41
Ideal treatment?
medium or intermediate acting synthetic , single morning dose
42
Treatment for asthma?
Beclomethasone dipropionate | budesonide,flunisolide and mometasone furoate
43
Treatment for allergic rhinitis?
Beclomethansone dipropionate, triamcinolone acetonide, budesonide, flunisolide, and momestasone furoate
44
excessive aldosterone can lead to?
hypokalemia, metabolic alkalosis, increased plasma volume, and hypertension
45
Account for specificty of mineralcorticoids in kidney?
enzyme 11 beta hydroxysteroid dehydrogenase type 2
46
Regulate DOC?
deoxycorticosterone is controlled by ACTH
47
increased DOC release?
adrenocortical carcinoma and congenital adrenal hyperplasia
48
Most widely used mineralcorticoid?
Fludrocortisone
49
Adrenal synthetic steroid?
P450c11 (11-hydroxylase) P450c17 (17-hydroxylase) P450c21 (21-hydroxylase)
50
Treatment for carcinoma of the breast?
Aminogltethimide | bloack conversion of cholesterol to pregnenolone
51
Aminogltethimide can also be used?
reduce steroid secretion in patients with Cushing's Syndrome
52
Ketoconazole?
an antifungal, inhibitory effects on steroid biosynthesis are seen at high doses used for Cushing's syndrome
53
Only adrenal inhibiting med administered to pregnant patient's with Cushing's syndrome?
Metyrapone
54
Metyrapone and Cushing Syndrome?
can reduce cortisol in endogenous Cushing Syndrome
55
adverse effects of Metyrapone?
salt and water rentention and hirsuitism
56
another use for Metyrapone?
test adrenal function
57
Mifeprisone 2 ways has antiglucocorticoid activity?
1 blocking glucocorticoid receptor, stablizie Hsp-glucocorticoid receptor complex and inhibit pf hte dissociation of RU-286 bound glucocorticoid receptor from the Hsp chaperone proteins 2 alter the interaction of glucocorticoid receptor with coregulators, favoring the formation of a transcriptionally inactive complex in the cell nucleus
58
Spironolactone MOA and clin use?
7alpha acetylthiosprionolactone used for primary aldosteronism, useful to establish signs and symptoms and when surgery is delayed, prep for surgery adrogen antagonist, treat hirtuism in women diruetic
59
treat hirtuism?
Spironolactone
60
Eplerenone MOA and clin use?
Aldosterone antagonist, treat hypertension | more selective than Spironolactone
61
Drospirenone MOA and clin use?
oral contraceptive | antagonizes the effects of aldosterone

MOD 1 Quiz 1 (15 decks)

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