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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
Q

Treatment for acute Adrenocortical insufficiecny?

A

large amount of parenteral hydrocortisone in addition to correction of fluid and electrolyte abnormalities (sodium succinate or phosphate)

26
Q

Treatment for Congenital Adrenal hyperplasia?

A

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
Q

Treatment for Cushing’s syndrome?

A

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
Q

Primary aldosteronism?

A

excessive production of aldosterone by an adrenal adenoma

29
Q

Treatment for primary aldosteronism?

A

Not with fludrocortisone (patients fail to retain sodium and secretion not reduced)

With spironolactone

30
Q

Glucocorticoids use for diagnosis?

A

dexamethasone is used because use of small quantities reduces the possibility of confusion in interpretation

31
Q

dexamthasone suppression test

A

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
Q

distinguish hypercortisolism due to anxiety, depression, and alcoholsim and Cushing’s?

A

combined test consisting of dexamethasone followed by standard corticotropin release hormone test

33
Q

Distinguish a patient with Cushing from steroid producing tumors?

A

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
Q

What type of synthetic glucocorticoids are better?

A

medium to intermediate acting, keep dose low

35
Q

Should therapy be stopped abruptly/ decreased?

A

no
cxr and tuberculin test for TB
ck for diabestes, peptic ulcer, osteoporosis, and pysch disturbance

36
Q

Cushing’s syndrome?

A

need for insulin, weight gain, myopathy, thinning of skin, osteoporosis, diabetes, aseptic necrosis of hip

37
Q

Long term effects of glucocorticoids?

A

hypokalemic, hypochlorinc alkalosis, rise in BP

38
Q

If dosage is reduced too rapidly?

A

anorexia, nausea, vomit, weight loss, lethargy, headache, fever, joint or muscle pain, postural hypotension

39
Q

Alternative day administration?

A

works because you allow recovery period between each dose, allowing large doses to be given

40
Q

treat severe autoimmune?

A

prednisone

41
Q

Ideal treatment?

A

medium or intermediate acting synthetic , single morning dose

42
Q

Treatment for asthma?

A

Beclomethasone dipropionate

budesonide,flunisolide and mometasone furoate

43
Q

Treatment for allergic rhinitis?

A

Beclomethansone dipropionate, triamcinolone acetonide, budesonide, flunisolide, and momestasone furoate

44
Q

excessive aldosterone can lead to?

A

hypokalemia, metabolic alkalosis, increased plasma volume, and hypertension

45
Q

Account for specificty of mineralcorticoids in kidney?

A

enzyme 11 beta hydroxysteroid dehydrogenase type 2

46
Q

Regulate DOC?

A

deoxycorticosterone is controlled by ACTH

47
Q

increased DOC release?

A

adrenocortical carcinoma and congenital adrenal hyperplasia

48
Q

Most widely used mineralcorticoid?

A

Fludrocortisone

49
Q

Adrenal synthetic steroid?

A

P450c11 (11-hydroxylase)
P450c17 (17-hydroxylase)
P450c21 (21-hydroxylase)

50
Q

Treatment for carcinoma of the breast?

A

Aminogltethimide

bloack conversion of cholesterol to pregnenolone

51
Q

Aminogltethimide can also be used?

A

reduce steroid secretion in patients with Cushing’s Syndrome

52
Q

Ketoconazole?

A

an antifungal, inhibitory effects on steroid biosynthesis are seen at high doses

used for Cushing’s syndrome

53
Q

Only adrenal inhibiting med administered to pregnant patient’s with Cushing’s syndrome?

A

Metyrapone

54
Q

Metyrapone and Cushing Syndrome?

A

can reduce cortisol in endogenous Cushing Syndrome

55
Q

adverse effects of Metyrapone?

A

salt and water rentention and hirsuitism

56
Q

another use for Metyrapone?

A

test adrenal function

57
Q

Mifeprisone 2 ways has antiglucocorticoid activity?

A

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
Q

Spironolactone MOA and clin use?

A

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
Q

treat hirtuism?

A

Spironolactone

60
Q

Eplerenone MOA and clin use?

A

Aldosterone antagonist, treat hypertension

more selective than Spironolactone

61
Q

Drospirenone MOA and clin use?

A

oral contraceptive

antagonizes the effects of aldosterone

MOD 1 Quiz 1 (15 decks)

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