Corticosteroids Flashcards
Are Hydrocortisone, Prednisone, and Methylprednisolone short to mediate, intermediate, or long-lasting glucocorticoids?
short to medium
Which drug is the only intermediate acting glucocorticoid?
Triamcinolone
Which drug is the only long-acting glucocorticoid?
Dexamethasone
What two drugs are
glucorticoid synthesis inhibitors and antagonists?
Ketoconazole and Metyrapone
What drug has both glucocorticoid and mineralcorticoid activity?
(note: this drug is also a mineralcorticoid agonist)
Fludrocortisone
Which drug is a mineralocorticoid antagonist?
Spironolactone
What is the precursor of ACTH?
POMC
In what region of the adrenal cortex is aldosterone, a mineralcorticoid, made in?
Zona glomerulosa
Glucosteroids, such as cortisol, are secreted from which part of the adrenal cortex?
Zona fasiculata
ACTH interacts with MCR (melanocortin receptor 2) in the _____
adrenal cortex
What is the rate-limiting step of cortisol biosynthesis?
Cholesterol to pregnenolone
Cholesterol converted to pregnenolone, from here ___ can be made (glucocorticoid pathway) and ___ can be made (mineralcorticoid pathway)
cortisol; aldosterone
What molecule can be used to measure cortisol metabolites in urine?
17-OH
Both ACTH and cortisol follow a ____ rhythm
diurnal (peak in the early morning)
Why do the effects of corticosteroids take some time to become visible?
Because they work via a ligand-bind receptor entering into the nucleus and causes gene transcription
Besides glucocorticoid receptor elements, the coricosteroid-bound complex influences the function of other transcription factors (AP1, NF-kB) which regulate: ____, ___, ____, and ____
GF’s, cytokines, anti-growth, anti-inflammatory, and immunosuppresive effects of glucosteroids
The glucocorticoid receptor can either make ____ proteins or inhibit the translation of inflammatory proteins
anti-inflammatory
In general, glucosteroids enhance production of ___ (and therefore gluconeogenesis) and release of ____
glucose; insulin
How do glucocorticoids affect proteins/amino acids?
More proteolysis/release of amino acids
How do glucocorticoids affect fat/fatty acids?
Enhance fatty acid mobilization and lipolysis
How does aldosterone affect water and electrolyte balance?
1) Reabsorption of sodium in renal tubules
2) Enhances renal excretion of K/H
How do glucocorticoids affect the heart?
-Vasoconstrict
-Decrease capillary permeability (reduce histamine release by mast/basophils)
What elements of the blood do glucocorticosteroids elevate?
Elevate: Hb, RBC’s/WBC, neutrophils
Glucocorticoids inhibit prostaglandins and ____ by inducing production of annexins, which inhibit ____
leukotriene
phospholipase A2
How do glucocorticosteroids reduce manifestations of inflammation?
Suppress release of inflammatory cytokines and chemokines
Why can glucocorticosteroids cause mood, sleep patterns, changes in mood, and adrenal insufficiency?
They are able to enter the CNS
How do glucocorticoids affect skeletal muscle?
Muscle weakness, pain, protelysis
What drug is most effective for treating vasogenic edema or brain abscess?
Prednisone
True or False:
Systemic administration of glucocorticosteroids can be useful in treating allergic rhinitis while inhaled steroids can treat mild to moderate asthma
True
What drugs can be useful in treating allergic disorders?
Short to medium acting
-hydrocortisone
-prednisone
-methylprednisolone
Medium
-Triamcinolone
Long
-Dexa
How do glucocorticoids reduce inflammation/brain edemain bacterial meningitis?
-Reduce TNF-a, IL-1, and prostglandin E2 in CSF
Which glucorticoids would make a good adjuncts to antimicrobial therapy in treatment of acute bacterial meningitis?
Dexamethasone
High doses of glucocorticoids are beneficial for acute exacerbations of ______ disorders
collagen
What two idiopathic inflammatory myopathies are glucosteroids the agents of choice for?
-Polymyositis
-Dematomyositis
All the glucocorticoid steroids except ___ are recommended for treatment of collagen disorders
Hydrocortisone
What two hematological disorders response well to glucocorticoid therapy? How does it do so?
1) autoimmune hemolytic anemia
2) idiopathic thrombocytopenic purpura
Mechanism: inhibits phagocytosis and increases platelet lifespan
What three glucorticoids are recommended for hematological disorders?
-Prednisone
-Triamcinoline
-Dexamethasone
What glucosteroid is used for initial treatment of subacute hepatic necrosis?
Prednisolone
What type of glucocorticoid is used to treat idiopathic nephrotic syndrome in patients less than 16 years of age?
Methylprednisolone
How is pulmonary sarcoidosis treated with glucocorticosteroids?
Prednisone (6-8 wks)
How can glucocorticosteroids help treat respiratory distress syndrome in premature neonates?
Betamethasone (24 hrs apart) or dexamethasone (4 does IM, 12 hrs apart)
Synergism with ___ may lead to increase GI events while taking glucocorticoids
NSAIDs
How do glucocorticoids decrease the protection provided by the gastric mucus barrier and, therefore, cause GI disturbance?
Increase gastric acid and pepsinogen production
Glucocorticoids may mask symptoms of ____ so that perforation or hemorrhage may occur without pain
peptic ulcers
In what types of patients can glucocorticoids cause fluid retention in?
Patients with heart or kidney disease
Enhanced gluconeogenesis and decreased cellular sensitivity to insulin can result in ____, or high glucose levels
hyperglycemia
High dose of glucocorticoids can cause metabolic alkalosis or ____, which is too little potassium
hypokalemia
True or False: severe hypokalemia can cause asthenia, paralysis, or arytthmias
True
True or False:
Incidence of hypokalemia is related to mineralocorticoid activity of specific glucorticoid
True
Although it is rare, glucocorticoids could cause low levels of phosphate (hyphosphatemia) which could cause cardiac dysfunction, ___, and ___
muscle weakness, hemolysis
Corticosteroids can cause osteonecrosis, which will most commonly effect the ____ ____
femoral head
Joint pain and stiffness noted 12 to 24 months after first corticosteroid treatment suggests ___
osteonecrosis
Osteonecrosis is commonly associated with ____ treatment or __doses
prolonged; high
True or False:
Corticosteroids can cause a positive nitrogen balance due to excessive breakdown of protein
False
Corticosteroids can cause a negative nitrogen balance due to excessive breakdown of protein
True or False:
High doses of corticosteroids may cause behavioral and personality changes, euphoria or psychotic episodes. These symptoms develop with days to weeks.
True
True or False:
Glucocorticoid therapy helps children grown, particularly when administered long term and daily
False - glucocorticoid therapy suppresses the growth of children, particularly when administered long term and daily
How can you prevent stunting children’s growth with glucocorticoid therapy?
1) single dose of short-acting steroid between 7-8 am
2) alternate day therapy with short-acting agent
True or False:
Glucocorticoid therapy can cause protein metabolism, myopathy, and gain of muscle mass
False
Glucocorticoid therapy can cause protein catabolism, myopathy, and loss of muscle mass
9a-fluronated steroids, such as ____, are known to have a high likelihood of causing myopathy?
Triamcinolone
True or False:
Skin thinning, purpura, non-melanoma skin cancers, acne, alopecia, and cushingoid features are common with glucosteroid use
True
True or False: Glucocorticoids maintain normal blood volume (salt retention)
False - mineralcorticoids (aldosterone) do this
What drug can be used to treat edema due to excess aldosterone? However: black box warning states tumors can arise from use.
Spirinolactone
Why are elevated triglycerides an adverse effect of glucosteroid use?
Lipolysis
What two conditions are babies who are exposed while in utero to glucosteroids more prone to?
1) fetal adrenal hypoplasia
2) hypoadrenalism
What drug is used to treat Addison’s Disease (1 insufficiency)?
Flurocortisone
In general, what drugs are used to treat hypoadrenalism?
Initially use hydrocortisone/cortisone; after hydrocortisone is tapered, fluorcortisone can be used
Facial redness and obesity are clinical features of what disease?
Cushing’s Syndrome (hypercortisolism)
What is the difference between Cushing Disease and Cushing Syndrome?
Cushing Disease: occurs when Cushing syndrome is caused by an ACTH-producing pituitary tumor
Cushing syndrome: symptoms that results when there is excess cortisol
What two drugs can be used to treat Cushing’s Syndrome? Which is most effective
1) Metyrapone (blocks cortisol/aldosterone production)
2) Ketoconazole (most effective because blocks ALL steroid biosynthesis)
Conn’s Syndrome, also known as ______, is normally treated with surgery. However, ___ can be administer prior to normalize potassium levels.
Hyperaldosteronism, spironolactone
If a patient presents with low cortisol, how can you determine whether they have pituitary or adrenal dysfunction?
Cosyntropin
-No rise in cortisol/17-OHCS (addison’s - adrenal failure)
-Slow rise in cortisol/17-OHCS (pituitary failure)
