Corticoids Flashcards
what is important to remember about ceasing treatment with corticoids?
body needs time to adjust to the lack of drug so taper off doses slowly
what hormone is responsible for 95% of the hormonal activity in the body? both names!
cortisol (hydrocortisone)
how does cortisol affect: gluconeogenesis, glycogen synthesis, serum glucose levels, lipolysis, and bone?
increases gluconeogensis increases glycogen synthesis increases serum glucose increases lipolysis (fat redistribution - Cushings!) catabolic effect on bone -> osteoporosis
describe the effects cortisol has on immune cells, specifically neutrophils vs all the others
cortisol INCREASES neutrophils in blood by increasing influx into blood from bone marrow and also decreasing their migration into tissues
it decreases all the others (T and B lymphocytes, monocytes, eosinophils, and basophils) by causing migration from blood into lymph tissues
what effects does cortisol have on peripheral vascular resistance? how?
vasoconstriction due to inhibition of mast cell degranulation (less histamine and capillary permeability)
describe the mechanism of action for cortisol and how it leads to its anti-inflammatory effects
it inhibits phospholipase A2 (popular test question!!)
and thus blocks release of arachidonic acid, the precursor to prostaglandins
also reduces synthesis of COX-2 and induces MAPK phosphatase I (which INHIBITS the MAPK proinflammatory pathways)
large doses of cortisol can cause what adverse effect?
increased intracranial pressure
why might a person develop peptic ulcers when being treated with cortisol?
cortisol suppresses the immune response to H. pylori
what injection do mother’s who are delivering prematurely receive to help with fetal lung development?
dexamethasone
how is cortisol absorbed across the skin vs mucous membranes?
diffuses poorly across the skin (unless its inflamed) but well across mucous membranes
which synthetic glucocorticoid penetrates airway mucosa and has low systemic toxicity?
Beclomethasone
how are synthetic glucocorticoids absorbed differently from cortisol?
synthetic ones are rapidly and completely absorbed orally (hydrocortisone isnt)
which has fewer salt-retaining effects, hydrocortisone or dexamethasone? why?
dex - all synthetic glucocorticoids have reduced salt retaining effects when compared to cortisol (hydrocortisone)
what is the only synthetic glucocorticoid that can be given IM?
Triamcinolone
what are the only two synthetic glucocorticoid that can be given aerosol?
Beclomethasone and Triamcinolone
what route can ALL synthetic glucocorticoids be given?
orally
mineralocorticoids activate the aldosterone receptor and lead to increased expression of what? (2)
Na/K ATPase and ENaC
what is the major role of mineralocorticoids?
salt-retention
what is the most commonly prescribed salt-retaining hormone? which has the highest salt retaining effects?
Fludrocortisone
aldosterone retains most salt (by a lot)
which two glucocorticoids have NO salt-retaining effects, and thus less side effects?
Triamcinolone and Dexamethasone
Person presents with weakness, fatigue, hypotension, low glucose during fasting, and salt-craving. What do they have and how do you treat?
Addison’s (left out hyperpigmentation mwuahaha)
give hydrocortisone + fludrocortisone
What DONT you give to a person with Addisons? name 2
long-acting glucocorticoids or ones without salt-retaining effects (no Dex or Triamcinolone)
Dex is long acting and neither have salt-retaining effects
how should treatment of Addison’s change under times of stress?
increase dose of hydrocortisone during stress
how do you treat acute adrenocortical insufficiency? (can be associated with shock, infection, or trauma)
immediate treatment with large amounts of parenteral hydrocortisone + fluid/electrolyte correction
give salt-retaining hormone (fludrocortisone) after 5 days (after hydrocortisone levels are reduced)
Most common CAH enzyme deficiency and its symptoms (general)
21-hydroxylase deficiency - inc sex hormones (no HTN)
what do you give to a patient before and after surgery to remove an ACTH-secreting pituitary adenoma? what is important to remember with this treatment?
high doses of cortisol - dose must be decreased slowly to prevent withdrawal
what do you give to a patient to treat hyperaldosteronism and how does it work?
spironolactone - receptor antagonist
dex suppresses which type of Cushing’s?
pituitary adenoma
which corticoid is useful in the treatment of Hodgkin’s lymphoma?
Prednisone
which drugs are useful in treating immunological inflammatory conditions? (generally)
synthetic corticosteroids
which corticoid is useful in treating cerebral edema?
dexamethasone
name the long acting glucocorticoid. how do its adverse effects compare to prednisone? why?
dexamethasone is long acting and long acting glucocorticoids have more adverse effects compared to short acting ones like prednisone
which group of drugs can be used to help prevent organ rejection after transplant?
synthetic corticosteroids
use of what group of drugs can lead to growth retardation in children?
synthetic corticosteroids
name an important adverse effect caused by long-acting steroids
myopathy (dex)
what happens if you abruptly withdraw treatment of steroids?
acute adrenal insufficiency (life-threatening)
which drug can be used to treat hirsutism in women?
spironolactone - mineralocorticoid receptor antagonist (can also act as androgen antagonist)
what can you give to a patient with inoperable ectopic ACTH syndrome or adrenal carcinoma - how does it work?
Mifepristone - antagonist at glucocorticoid and progesterone receptors
which drug blocks the conversion of cholesterol to pregnenolone and is used to treat adrenal cancer (with cortisol or dex as co-treatment)?
Aminoglutethimide
what drug is a potent and non-selective inhibitor of adrenal and gonadal steroid synthesis and is used in the treatment of Cushing’s syndrome and prostate cancer?
Ketoconazole
what drug is a relatively selective inhibitor of steroid 11-hydroxylation (prevents synthesis of cortisol and corticosterone) and is used to test adrenal function?
Metyrapone
which drug is given to pregnant women with Cushing’s? MOA?
Metyrapone - relatively selective inhibitor of steroid 11-hydroxylation
