CORTICOID THERAPY

Question 1

What is a mineralocorticoid?

Answer 1

a corticosteroid that is involved with maintaining the salt balance in the body e.g. aldosterone

Question 2

what is a glucocorticoids?

Answer 2

any group of corticosteroid involved in the metabolism of carbs, proteins and fats and have an anti-inflammatory activity

Question 3

what are catecholamines?

Answer 3

any of a class of aromatic amines which includes a number of neurotransmitters
adrenaline and dopamine

Question 4

what are the 3 distinct regions of the adrenal gland?

Answer 4

capsule, adrenal cortex, adrenal medulla

Question 5

what are the 3 distinct zones of the adrenal cortex?

Answer 5

zona glomerulosa
zona fasiculata
zona reticular is

Question 6

which zone of the adrenal cortex can contain lipofuscin?

Answer 6

zona reticular is

Question 7

what hormones does the zona glomerulosa release?

Answer 7

mineralocorticoids

Question 8

what hormones does the zona fasiculata release?

Answer 8

glucocorticoids

Question 9

what hormones does the zona reticularis release?

Answer 9

androgens

e.g. dehydroepiandrosterone

Question 10

what hormone does the adrenal medulla release?

Answer 10

stress hormones e.g. noradrenaline and

Question 11

what does dehydroepiandrosterone help produce?

Answer 11

testosterone and oestrogen

Question 12

whats the function of mineralocorticoids?

Answer 12

promote sodium and potassium transport, usually followed by changes in water balance -> key role in bp and normal CO

Question 13

outline the moa of mineralocorticoids?

Answer 13

they can bind to mineralcorticoid receptors inside the cell, it can move to the nucleus to drive gene expression. This activates the Na+ transporter which can be transported to the surface to increase Na+ uptae and therefore water will follow

Question 14

whats an example of a mineralocorticoid?

Answer 14

aldosterone

Question 15

what are examples of mineralocorticoid antagonists?

Answer 15

Spironolactone and eplerenone

Question 16

outline the production chain of mineralocorticoids?

Answer 16

cholesterol -> pregnenolone -> 11-deoxycorticosterone -> corticosterone -> aldosterone

Question 17

where does angiotensin 2 exert its effect?

Answer 17

on the enzyme that converts corticosterone to aldosterone

Question 18

what is conn’s syndrome?

Answer 18

primar hyperaldosteronism

Question 19

what is primary hyperaldosteronism?

Answer 19

a condition that occurs when the adrenal glands produce too much aldosterone - leading to hypertension and hypokalaemia

Question 20

what is secondary hyperaldosteronism?

Answer 20

increased adrenal production of aldosterone in response to nonpituitary, extra-adrenal stimuli such as renal hypoperfusion.

Question 21

whats the function of glucocorticoids?

Answer 21

prmotes overall catabolic effects in the body; in adipose tissue it triggers lipolysis, in the muscle it stimulates proteolysis. These free fatty acids and amino acids serve as a substrate for gluconeogenesis. At the same times it decreases cellular utilization of glucose. This increases the output of glucose from the liver. they can also increase insulin resistance in tissues which means that insulin becomes less effective at moving glucose into cells, leading to an increase in blood glucose levels; this in turn then stimulates the release of more insulin. The end result is a lot more glucose in the blood to use as fuel during times of stress.
They also help regulate the immune response by inhibiting prostaglandins and leukotrienes and interluekin 2 production by WBCs.

Finalyl, they play a role in maintaining bp levels since it up-regulates alpha 1 adrenergic receptors in blood vessels, causing vasoconstriction.

Question 22

what are glucocorticoids moa?

Answer 22

cross the cell membranes and bind with the cytoplasmic receptor protein called a glucocorticoid receptor, Now this complex can enter the nucleus and bind with glucocorticoid respeone elements. Thus induces transcription of specific mRNA thats used t synthesize different proteins which in turn modifies various cell functions and metabolic effects in the body.

Question 23

how are glucocorticoids produced?

Answer 23

cholesterol -> pregnolone -> 17-alpha-hydoxypregenolone -? 17-alpha hydroxyprogesterone -> 11-deoxycortisol -> hydrocortisone

Question 24

what effects do synthetic glucocorticoids have?

Answer 24

the same as endogenous glucocorticoids but also increase the number of neutrophils in the blood through demmargination (and prevent their apoptosis)
they can also decrease lymphocyte, monocyte, basophil and eosinophil counts

Question 25

what are examples of short acting glucocorticoids?

Answer 25

cortisone and hydrocortisone

Question 26

whats the difference between cortisone and hydrocortisone?

Answer 26

cortisone is taken orally and converted to hydrocortisone in the liver whilst hydrocortisone is already active so can be taken oral, IV or IM

Question 27

what are examples of intermediate acting glucocorticoids?

Answer 27

prednisone prednisolone methylprednisolone triamcinolone

Question 28

what are corticosteroids?

Answer 28

steroid drugs that closely relate to cortisol (glucocorticoid)

Question 29

what are some examples of long acting glucocorticoids?

Answer 29

betamethasone and dexamethasone

Question 30

what steroid is in the brown inhaler?

Answer 30

beclometasone

Question 31

what steroid is given to pregnant women before birth to speed up foetal lung maturation?

Answer 31

betamethasone

Question 32

whats the production chain for androgens?

Answer 32

cholesterol -> pregnenolone -> 17-alpga-hydroxypregenolone -> dehydroepiandrosterone -> androstenedione -> testosterone -> oestradiol

Question 33

whats the cause the congenital adrenal hyperplasia?

Answer 33

The most common enzyme defect, 21-hydroxylase deficiency, leads to excess amounts of male hormones being produced by the adrenal glands because there is an increase in metabolites that couldn't be used to synthesis glucocorticoids and mineralocorticoids

Question 34

outline the HPA axis for glucocorticoids?

Answer 34

hypothalamus secretes corticotrophin releasing factor which stimulates the anterior pituitary to secrete adrenocorticotrophic hormone. This stimulates the adrenal cortex to produce glucocorticoids. The increase in glucocorticoids suppresses the hypothalamus to stop it secreting CRF

Question 35

what are examples of using physiological dosing of glucocorticoids?

Answer 35

this is when you are trying to replace steroid levels e.g. Addisons disease

Question 36

why do you need to slowly reduce a patients dosing of steroids to wean them off it?

Answer 36

because when you give steroids, edogenous steroid production is suppressed which can lead to the adrenal gland shrinking overtime so when a patient then needs to be able to make endogenous steroids, they may not be able to do so effectively

Question 37

what is cushings syndrome?

Answer 37

too much cortisol in the body

Question 38

what are some effects of cushings syndrome?

Answer 38

``` CNS irritability red round face hypertension cardiac hypertrophy purple striae skin ulcers muscle wasting osteoporosos obesity aemonorrhoea erectile dysfunction ```

Question 39

what is secondary adrenal insufficiency?

Answer 39

Secondary adrenal insufficiency occurs when the pituitary gland doesn't make enough of the hormone ACTH

Question 40

whats the test to see if the body can effectively produce ACTH?

Answer 40

give metyrapone which blocks the production of hydrocortisone. This should drive the production of ACTH

Question 41

which steroids have glucocorticoid and mineralocorticoid activity?

Answer 41

hydrocortisone cortisone fludrocortisone

Question 42

which steroids have predominantly glucocorticoid activity?

Answer 42

prednisone prednisolone methylprednisolone dexamethasone

Question 43

which steroids have only glucocorticoids activity?

Answer 43

triamcinolone and betamethasone