Corticosteroid

Question 1

Hydrocortisone

Answer 1

short-acting glucocorticoid
synthesized from cholesterol
potent mineralocorticoid
tx hypoadrenalism, anti-inflammatory, dermal, adjunctive ulcerative colitis

Question 2

Prednisone

Answer 2

short-acting gluococorticoid
synthetic, hepatic metabolism to active metabolite prednisolone
slight mineralocorticoid activity
tx allergic disorders, cerebral edema, collegen disorders, hematological disorders, pulmonary sarcoidosis, dermatologic conditions

Question 3

methylprednisone

Answer 3

short-acting glucocorticoid

tx allergic disorders, collagen disorders, idiopathic nephrotic syndrome in kids

Question 4

triamcinolone

Answer 4

intermediate-acting glucocorticoid
synthetic, hepatic metabolism
no mineralocorticoid activity
tx allergic disorders - allergic rhinitis, bronchial asthma, collagen disorders, adrenocortical insufficiency, intralesional uses

Question 5

dexamethaxone

Answer 5

long-acting glucocorticoid
synthetic
no mineralocorticoid activity
tx allergic disorders, non- TB bacterial meningitis, collagen disorders, hematological disorders, respiratory distress syndrome given 24 hours before birth, conjunctivitis, otic inflammation or edema in external ear

Question 6

metyrapone

Answer 6

glucocorticoid synthesis inhibitor/antagonist
tx hypercortisolism or cushing’s syndrome
inhibits only cortisol and aldosterone
added on to ketoconazole if needed, works synergistically w/ ketoconazole

Question 7

ketoconazole

Answer 7

glucocorticoid synthesis inhibitor/antagonist
tx cushings syndrome
most effective drug for cushing’s disease
blocks all steroids

Question 8

fludrocortisone

Answer 8

mineralocorticoid
some glucocorticoid potency
tx hypoadrenalism,

Question 9

sprionolactone

Answer 9

glucocorticoid and mineralocorticoid antagonist

normalize potassium concentration with conn’s syndrome or hyperaldosteronism, manage edema due to excessive aldosterone

Question 10

cosyntropin

Answer 10

glucocorticoid, mineralocorticoid, androgen, pregesterone and estrogen agonist
test adrenal fcn
normally, iv levels peak 1 hr later
cortisol increases only after prolonged tx - pituitary or hypothalamic dysfunction
cortisol does not increase at all, adrenal dysfunction
hypersensitivity rcn

Question 11

zona glomerulosa

Answer 11

mineralocorticoids

aldosterone

Question 12

zona fasciculata

Answer 12

glucocorticoids

cortisol

Question 13

zona reticularis

Answer 13

androgens, progesterone, estrogen

Question 14

physiologic effects of glucocorticoids

Answer 14

maintain adequate blood supply to the brain - enhance glucose production - hepatic gluconeogenesis, decrease peripheral glucose utilization, increase proteolysis, lipolysis
suppress mast cell degranulation- vasoconstriction, reduce histamine release
increase RBCs and neutrophils
decrease other WBCs
inhibit prostaglandin and leukotriene, cytokine and chemokine - reduce inflammation
CNS - cross BBB and influence mood and sleep
maintain skeletal muscle strength
protects during stress

Question 15

non-endocrine uses of glucocorticoids

Answer 15

allergic disorders - mild asthma, symptoms, adjunct in anaphylaxis
cerebral edema - brain abscess causing vasogenic type edema
bacterial meningitis - anti-inflammatory effects, adjuncts to acute, non-TB bacterial meningitis
collagen - high doses for exacerbations, SLE, lupus nephritis, polymyosistis, dermatomyositis, polymyalgia rheumatica
hematological disorder - autoimmune hemolytic anemia, idiopathic thromybocytopenic purpura
hepatic - subacute hepatic necrosis, autoimmune chronic hepatitis
renal - idiopathic nephrotic syndrome in kids
respiratory - pulmonary sarcoidosis, respiratory distress syndrome in premies antenatal

Question 16

glucocorticoid SE

Answer 16

GI, edema, hyperglycemia, hypokalemia, hyphosphatemia, osteonecrosis, negative nitrogen balance, CNS, growth suppression in kids, myopathy, skin thinning, non-melanoma skin cancers, glaucoma, cataracts, corneal perforation, more inflections, HPA supression, cross placenta - fetal adrenal hypoplasia, increase cleft palate risk

Question 17

physiologic effects of mineralcorticoids

Answer 17

reabsorb sodium with potassium and hydrogen excretion

SE - hypokalemia, metabolic alkalosis, increase in plasma volume and hypertension

Question 18

SE of mineralcorticoids

Answer 18

CV - HTN, edema
CNS - convulsions, headache, dizziness
derm - rash
endocrine and metabolic- hyperglycemia, HPA suppression, suppression of growth
GI - peptic ulcer
muscle weakness, cataracts