Anti-Inflammatory Corticosteroids

Question 1

Addison’s disease requires _________.

Answer 1

cortisol supplementation

Question 2

Cushing’s disease results from _________.

Answer 2

excess endogenous cortisol

Question 3

Once you administer glucocorticoids for a significant time, you need to __________.

Answer 3

continue administering it, because the exogenous glucocorticoids inhibits pituitary release of ACTH

Question 4

ACTH (also called ________) is acts on the ________.

Answer 4

adrenocorticotropin hormone; adrenal glands to stimulate cortisol production

Question 5

CRF (____________) is released by the ________ and acts on the ________.

Answer 5

corticotropin-releasing factor; hypothalamus; pituitary

Question 6

ACTH inhibits _______.

Answer 6

CRF release from the hypothalamus

Question 7

Pituitary release of ________ is inhibited by ________.

Answer 7

ACTH; glucocorticoids

Question 8

What are the metabolic symptoms of Cushing’s disease/excess glucocorticoids?

Answer 8

Diabetes (due to increased gluconeogenesis), obesity, muscle wasting (due to AA shuttle to liver), skin atrophy,

Question 9

What are the mineralocorticoid effects of aldosterone?

Answer 9

Sodium retention (and consequent increased water reabsorption from the kidneys resulting in increased BP); metabolic alkalosis; hypokalemia

Question 10

Immunologically, glucocorticoids ______.

Answer 10

suppress the immune response by decreasing lymphocyte activation and restricting vasodilation

Question 11

Cortisol has a ______ backbone.

Answer 11

cholesterol

Question 12

Prednisone and cortisone have to __________.

Answer 12

be metabolized in the liver to the active prednisolone and cortisol

Question 13

________ inhibits the mineralocorticoid action while _______ stimulates it.

Answer 13

Dexamethasone; fludrocortisone

Question 14

Aldosterone ______ potassium levels.

Answer 14

lowers (if you don’t have enough aldosterone, such as in Addison’s, you will be hyperkalemic)

Question 15

In the kidneys, ______ converts cortisol to cortisone, thus ensuring that aldosterone is the primary glucocorticoid regulator in the kidneys.

Answer 15

11Beta-HSD2

Question 16

The most potent anti-inflammatory is ______.

Answer 16

dexamethasone (Decadron)

Question 17

Which two glucocorticoids have to go through the liver?

Answer 17

Cortisone and prednisone

Question 18

______________ are released in concert with cortisol, but not aldosterone.

Answer 18

Adrenal androgens (such as dihydroandostenedione and androstenedione)

Question 19

Endogenous and exogenous glucocorticoids negatively affect the ___________.

Answer 19

hypothalamus and pituitary (production of CRF and ACTH, respectively)

Question 20

In the plasma, cortisol is ________.

Answer 20

bound to cortisol-binding globulin (CBG)

Question 21

Once in the cell, cortisol ___________.

Answer 21

dimerizes with R, forming R-S complex that binds the response element on DNA

Question 22

The half-life of cortisol is roughly ______.

Answer 22

60 - 90 minutes

Question 23

Aldosterone works by ________.

Answer 23

activating transcription factors (in the nucleus) that produce protein for sodium and potassium resorption–leading to increased water retention

Question 24

What are the two ways glucocorticoids antagonize inflammation?

Answer 24

They (1) inhibit the synthesis of IL-1 to IL-6, IL-8, GM-CSF, and TNF, and they (2) inhibit the production of arachidonic acid metabolites

Question 25

The inactivating enzyme is _______, while the activating enzyme is _______.

Answer 25

11Beta-HSD2; 11Beta-HSD1

Question 26

The alternate-day schedule __________.

Answer 26

lessens adverse effects, because the anti-inflammatory effects outlast the HPA effects

Question 27

What do mineralocorticoids do to potassium levels?

Answer 27

Decrease

Question 28

Excess aldosterone can lead to _______.

Answer 28

hypertension, increased blood volume, hypokalemia, and metabolic alkalosis

Question 29

The glucocorticoid with the best topical activity is ________.

Answer 29

triamcinolone