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Pharm Final > Corticoids > Flashcards

Corticoids Flashcards

1
Q

what is important to remember about ceasing treatment with corticoids?

A

body needs time to adjust to the lack of drug so taper off doses slowly

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2
Q

what hormone is responsible for 95% of the hormonal activity in the body? both names!

A

cortisol (hydrocortisone)

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3
Q

how does cortisol affect: gluconeogenesis, glycogen synthesis, serum glucose levels, lipolysis, and bone?

A 
increases gluconeogensis
increases glycogen synthesis
increases serum glucose
increases lipolysis (fat redistribution - Cushings!)
catabolic effect on bone -> osteoporosis
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4
Q

describe the effects cortisol has on immune cells, specifically neutrophils vs all the others

A

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

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5
Q

what effects does cortisol have on peripheral vascular resistance? how?

A

vasoconstriction due to inhibition of mast cell degranulation (less histamine and capillary permeability)

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6
Q

describe the mechanism of action for cortisol and how it leads to its anti-inflammatory effects

A

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)

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7
Q

large doses of cortisol can cause what adverse effect?

A

increased intracranial pressure

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8
Q

why might a person develop peptic ulcers when being treated with cortisol?

A

cortisol suppresses the immune response to H. pylori

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9
Q

what injection do mother’s who are delivering prematurely receive to help with fetal lung development?

A

dexamethasone

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10
Q

how is cortisol absorbed across the skin vs mucous membranes?

A

diffuses poorly across the skin (unless its inflamed) but well across mucous membranes

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11
Q

which synthetic glucocorticoid penetrates airway mucosa and has low systemic toxicity?

A

Beclomethasone

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12
Q

how are synthetic glucocorticoids absorbed differently from cortisol?

A

synthetic ones are rapidly and completely absorbed orally (hydrocortisone isnt)

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13
Q

which has fewer salt-retaining effects, hydrocortisone or dexamethasone? why?

A

dex - all synthetic glucocorticoids have reduced salt retaining effects when compared to cortisol (hydrocortisone)

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14
Q

what is the only synthetic glucocorticoid that can be given IM?

A

Triamcinolone

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15
Q

what are the only two synthetic glucocorticoid that can be given aerosol?

A

Beclomethasone and Triamcinolone

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16
Q

what route can ALL synthetic glucocorticoids be given?

A

orally

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17
Q

mineralocorticoids activate the aldosterone receptor and lead to increased expression of what? (2)

A

Na/K ATPase and ENaC

18
Q

what is the major role of mineralocorticoids?

A

salt-retention

19
Q

what is the most commonly prescribed salt-retaining hormone? which has the highest salt retaining effects?

A

Fludrocortisone

aldosterone retains most salt (by a lot)

20
Q

which two glucocorticoids have NO salt-retaining effects, and thus less side effects?

A

Triamcinolone and Dexamethasone

21
Q

Person presents with weakness, fatigue, hypotension, low glucose during fasting, and salt-craving. What do they have and how do you treat?

A

Addison’s (left out hyperpigmentation mwuahaha)

give hydrocortisone + fludrocortisone

22
Q

What DONT you give to a person with Addisons? name 2

A

long-acting glucocorticoids or ones without salt-retaining effects (no Dex or Triamcinolone)

Dex is long acting and neither have salt-retaining effects

23
Q

how should treatment of Addison’s change under times of stress?

A

increase dose of hydrocortisone during stress

24
Q

how do you treat acute adrenocortical insufficiency? (can be associated with shock, infection, or trauma)

A

immediate treatment with large amounts of parenteral hydrocortisone + fluid/electrolyte correction

give salt-retaining hormone (fludrocortisone) after 5 days (after hydrocortisone levels are reduced)

25
Q

Most common CAH enzyme deficiency and its symptoms (general)

A

21-hydroxylase deficiency - inc sex hormones (no HTN)

26
Q

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?

A

high doses of cortisol - dose must be decreased slowly to prevent withdrawal

27
Q

what do you give to a patient to treat hyperaldosteronism and how does it work?

A

spironolactone - receptor antagonist

28
Q

dex suppresses which type of Cushing’s?

A

pituitary adenoma

29
Q

which corticoid is useful in the treatment of Hodgkin’s lymphoma?

A

Prednisone

30
Q

which drugs are useful in treating immunological inflammatory conditions? (generally)

A

synthetic corticosteroids

31
Q

which corticoid is useful in treating cerebral edema?

A

dexamethasone

32
Q

name the long acting glucocorticoid. how do its adverse effects compare to prednisone? why?

A

dexamethasone is long acting and long acting glucocorticoids have more adverse effects compared to short acting ones like prednisone

33
Q

which group of drugs can be used to help prevent organ rejection after transplant?

A

synthetic corticosteroids

34
Q

use of what group of drugs can lead to growth retardation in children?

A

synthetic corticosteroids

35
Q

name an important adverse effect caused by long-acting steroids

A

myopathy (dex)

36
Q

what happens if you abruptly withdraw treatment of steroids?

A

acute adrenal insufficiency (life-threatening)

37
Q

which drug can be used to treat hirsutism in women?

A

spironolactone - mineralocorticoid receptor antagonist (can also act as androgen antagonist)

38
Q

what can you give to a patient with inoperable ectopic ACTH syndrome or adrenal carcinoma - how does it work?

A

Mifepristone - antagonist at glucocorticoid and progesterone receptors

39
Q

which drug blocks the conversion of cholesterol to pregnenolone and is used to treat adrenal cancer (with cortisol or dex as co-treatment)?

A

Aminoglutethimide

40
Q

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?

A

Ketoconazole

41
Q

what drug is a relatively selective inhibitor of steroid 11-hydroxylation (prevents synthesis of cortisol and corticosterone) and is used to test adrenal function?

A

Metyrapone

42
Q

which drug is given to pregnant women with Cushing’s? MOA?

A

Metyrapone - relatively selective inhibitor of steroid 11-hydroxylation

Pharm Final (20 decks)

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