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Pharmacology > Corticosteroids > Flashcards

Corticosteroids Flashcards

1
Q

Are Hydrocortisone, Prednisone, and Methylprednisolone short to mediate, intermediate, or long-lasting glucocorticoids?

A

short to medium

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2
Q

Which drug is the only intermediate acting glucocorticoid?

A

Triamcinolone

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3
Q

Which drug is the only long-acting glucocorticoid?

A

Dexamethasone

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4
Q

What two drugs are
glucorticoid synthesis inhibitors and antagonists?

A

Ketoconazole and Metyrapone

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5
Q

What drug has both glucocorticoid and mineralcorticoid activity?
(note: this drug is also a mineralcorticoid agonist)

A

Fludrocortisone

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6
Q

Which drug is a mineralocorticoid antagonist?

A

Spironolactone

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7
Q

What is the precursor of ACTH?

A

POMC

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8
Q

In what region of the adrenal cortex is aldosterone, a mineralcorticoid, made in?

A

Zona glomerulosa

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9
Q

Glucosteroids, such as cortisol, are secreted from which part of the adrenal cortex?

A

Zona fasiculata

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10
Q

ACTH interacts with MCR (melanocortin receptor 2) in the _____

A

adrenal cortex

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11
Q

What is the rate-limiting step of cortisol biosynthesis?

A

Cholesterol to pregnenolone

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12
Q

Cholesterol converted to pregnenolone, from here ___ can be made (glucocorticoid pathway) and ___ can be made (mineralcorticoid pathway)

A

cortisol; aldosterone

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13
Q

What molecule can be used to measure cortisol metabolites in urine?

A

17-OH

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14
Q

Both ACTH and cortisol follow a ____ rhythm

A

diurnal (peak in the early morning)

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15
Q

Why do the effects of corticosteroids take some time to become visible?

A

Because they work via a ligand-bind receptor entering into the nucleus and causes gene transcription

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16
Q

Besides glucocorticoid receptor elements, the coricosteroid-bound complex influences the function of other transcription factors (AP1, NF-kB) which regulate: ____, ___, ____, and ____

A

GF’s, cytokines, anti-growth, anti-inflammatory, and immunosuppresive effects of glucosteroids

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17
Q

The glucocorticoid receptor can either make ____ proteins or inhibit the translation of inflammatory proteins

A

anti-inflammatory

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18
Q

In general, glucosteroids enhance production of ___ (and therefore gluconeogenesis) and release of ____

A

glucose; insulin

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19
Q

How do glucocorticoids affect proteins/amino acids?

A

More proteolysis/release of amino acids

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20
Q

How do glucocorticoids affect fat/fatty acids?

A

Enhance fatty acid mobilization and lipolysis

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21
Q

How does aldosterone affect water and electrolyte balance?

A

1) Reabsorption of sodium in renal tubules

2) Enhances renal excretion of K/H

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22
Q

How do glucocorticoids affect the heart?

A

-Vasoconstrict
-Decrease capillary permeability (reduce histamine release by mast/basophils)

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23
Q

What elements of the blood do glucocorticosteroids elevate?

A

Elevate: Hb, RBC’s/WBC, neutrophils

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24
Q

Glucocorticoids inhibit prostaglandins and ____ by inducing production of annexins, which inhibit ____

A

leukotriene
phospholipase A2

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25
Q

How do glucocorticosteroids reduce manifestations of inflammation?

A

Suppress release of inflammatory cytokines and chemokines

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26
Q

Why can glucocorticosteroids cause mood, sleep patterns, changes in mood, and adrenal insufficiency?

A

They are able to enter the CNS

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27
Q

How do glucocorticoids affect skeletal muscle?

A

Muscle weakness, pain, protelysis

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28
Q

What drug is most effective for treating vasogenic edema or brain abscess?

A

Prednisone

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29
Q

True or False:
Systemic administration of glucocorticosteroids can be useful in treating allergic rhinitis while inhaled steroids can treat mild to moderate asthma

A

True

30
Q

What drugs can be useful in treating allergic disorders?

A

Short to medium acting
-hydrocortisone
-prednisone
-methylprednisolone

Medium
-Triamcinolone

Long
-Dexa

31
Q

How do glucocorticoids reduce inflammation/brain edemain bacterial meningitis?

A

-Reduce TNF-a, IL-1, and prostglandin E2 in CSF

32
Q

Which glucorticoids would make a good adjuncts to antimicrobial therapy in treatment of acute bacterial meningitis?

A

Dexamethasone

33
Q

High doses of glucocorticoids are beneficial for acute exacerbations of ______ disorders

A

collagen

34
Q

What two idiopathic inflammatory myopathies are glucosteroids the agents of choice for?

A

-Polymyositis
-Dematomyositis

35
Q

All the glucocorticoid steroids except ___ are recommended for treatment of collagen disorders

A

Hydrocortisone

36
Q

What two hematological disorders response well to glucocorticoid therapy? How does it do so?

A

1) autoimmune hemolytic anemia
2) idiopathic thrombocytopenic purpura

Mechanism: inhibits phagocytosis and increases platelet lifespan

37
Q

What three glucorticoids are recommended for hematological disorders?

A

-Prednisone
-Triamcinoline
-Dexamethasone

38
Q

What glucosteroid is used for initial treatment of subacute hepatic necrosis?

A

Prednisolone

39
Q

What type of glucocorticoid is used to treat idiopathic nephrotic syndrome in patients less than 16 years of age?

A

Methylprednisolone

40
Q

How is pulmonary sarcoidosis treated with glucocorticosteroids?

A

Prednisone (6-8 wks)

41
Q

How can glucocorticosteroids help treat respiratory distress syndrome in premature neonates?

A

Betamethasone (24 hrs apart) or dexamethasone (4 does IM, 12 hrs apart)

42
Q

Synergism with ___ may lead to increase GI events while taking glucocorticoids

A

NSAIDs

43
Q

How do glucocorticoids decrease the protection provided by the gastric mucus barrier and, therefore, cause GI disturbance?

A

Increase gastric acid and pepsinogen production

44
Q

Glucocorticoids may mask symptoms of ____ so that perforation or hemorrhage may occur without pain

A

peptic ulcers

45
Q

In what types of patients can glucocorticoids cause fluid retention in?

A

Patients with heart or kidney disease

46
Q

Enhanced gluconeogenesis and decreased cellular sensitivity to insulin can result in ____, or high glucose levels

A

hyperglycemia

47
Q

High dose of glucocorticoids can cause metabolic alkalosis or ____, which is too little potassium

A

hypokalemia

48
Q

True or False: severe hypokalemia can cause asthenia, paralysis, or arytthmias

A

True

49
Q

True or False:
Incidence of hypokalemia is related to mineralocorticoid activity of specific glucorticoid

A

True

50
Q

Although it is rare, glucocorticoids could cause low levels of phosphate (hyphosphatemia) which could cause cardiac dysfunction, ___, and ___

A

muscle weakness, hemolysis

51
Q

Corticosteroids can cause osteonecrosis, which will most commonly effect the ____ ____

A

femoral head

52
Q

Joint pain and stiffness noted 12 to 24 months after first corticosteroid treatment suggests ___

A

osteonecrosis

53
Q

Osteonecrosis is commonly associated with ____ treatment or __doses

A

prolonged; high

54
Q

True or False:
Corticosteroids can cause a positive nitrogen balance due to excessive breakdown of protein

A

False
Corticosteroids can cause a negative nitrogen balance due to excessive breakdown of protein

55
Q

True or False:
High doses of corticosteroids may cause behavioral and personality changes, euphoria or psychotic episodes. These symptoms develop with days to weeks.

A

True

56
Q

True or False:
Glucocorticoid therapy helps children grown, particularly when administered long term and daily

A

False - glucocorticoid therapy suppresses the growth of children, particularly when administered long term and daily

57
Q

How can you prevent stunting children’s growth with glucocorticoid therapy?

A

1) single dose of short-acting steroid between 7-8 am
2) alternate day therapy with short-acting agent

58
Q

True or False:
Glucocorticoid therapy can cause protein metabolism, myopathy, and gain of muscle mass

A

False
Glucocorticoid therapy can cause protein catabolism, myopathy, and loss of muscle mass

59
Q

9a-fluronated steroids, such as ____, are known to have a high likelihood of causing myopathy?

A

Triamcinolone

60
Q

True or False:
Skin thinning, purpura, non-melanoma skin cancers, acne, alopecia, and cushingoid features are common with glucosteroid use

A

True

61
Q

True or False: Glucocorticoids maintain normal blood volume (salt retention)

A

False - mineralcorticoids (aldosterone) do this

62
Q

What drug can be used to treat edema due to excess aldosterone? However: black box warning states tumors can arise from use.

A

Spirinolactone

63
Q

Why are elevated triglycerides an adverse effect of glucosteroid use?

A

Lipolysis

64
Q

What two conditions are babies who are exposed while in utero to glucosteroids more prone to?

A

1) fetal adrenal hypoplasia
2) hypoadrenalism

65
Q

What drug is used to treat Addison’s Disease (1 insufficiency)?

A

Flurocortisone

66
Q

In general, what drugs are used to treat hypoadrenalism?

A

Initially use hydrocortisone/cortisone; after hydrocortisone is tapered, fluorcortisone can be used

67
Q

Facial redness and obesity are clinical features of what disease?

A

Cushing’s Syndrome (hypercortisolism)

68
Q

What is the difference between Cushing Disease and Cushing Syndrome?

A

Cushing Disease: occurs when Cushing syndrome is caused by an ACTH-producing pituitary tumor

Cushing syndrome: symptoms that results when there is excess cortisol

69
Q

What two drugs can be used to treat Cushing’s Syndrome? Which is most effective

A

1) Metyrapone (blocks cortisol/aldosterone production)

2) Ketoconazole (most effective because blocks ALL steroid biosynthesis)

70
Q

Conn’s Syndrome, also known as ______, is normally treated with surgery. However, ___ can be administer prior to normalize potassium levels.

A

Hyperaldosteronism, spironolactone

71
Q

If a patient presents with low cortisol, how can you determine whether they have pituitary or adrenal dysfunction?

A

Cosyntropin
-No rise in cortisol/17-OHCS (addison’s - adrenal failure)

-Slow rise in cortisol/17-OHCS (pituitary failure)

Pharmacology (53 decks)

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