Corticosteroids

Question 1

Glucocorticoids function

Answer 1

-Increase Bp (by upregulation alpha1 receptors on arterioles)
-Increase apetite
-decrease bone formation (decreased osteoblast activity)
- inhibiting PLA2 to prevent arachidonic acid formation leading to a restriction in activity of COX and LOX
- inhibit NF-KB preventing recruitment and activation of T and B cells
-decrease in perioheral eosinophil count
-prevent production of neutrophil adhesion molecules leading to neutrophilia
- stimulate gluconeogenesis and increase glycogen storage in the liver causing hyperglycemia

Question 2

Mineralocorticoids function

Answer 2

Aldosterone in principal cells cause K+ secretion and in alpha intercalated cells cause H+ secretion in exchange for Na+ and water staying inside the body

Question 3

Inhibitors of aldosterone activity

Answer 3

Spironolactone (used for HF, antiandrogen, hirsutism), eplerenone and ketoconazole (antifungal, steroid synthesis inhibitor)

Question 4

Therapeutic uses of corticoids

Answer 4

-Replacement therapy for primary, secondary and tertiary adrenocortical insufficiency: hydrocortisone (2/3 in the morning and 1/3 in the evening) or fludrocortisone
-immunosuppressive therapy
-treatment of inflammatory disorders
-replacement therapy for congenital adrenal hyperplasia
-diagnosis of Cushing’s syndrome: high levels of cortisole or dexamethasone usage
-acceleration of lung maturation for premature babies given 48 hours before birth to the mother

Question 5

Adverse effects

Answer 5

Palmar erythema, moon facies, ecchymosis/ purpura, poor wound healing, purple striae, skin thinning, acne, hyperpigmentation, dorsocervical fat pad
Osteoporosis, avascular bone necrosis, irregular menstrual cycle, hypertension, glaucoma, cataract, peptic ulcers, hyperglycemia, central obesity, muscle atrophy, hirsutism
Insomnia, mood swings, psychosis, decreased libido

Question 6

Names of glucocorticoids

Answer 6

Dexamethasone, prednisone (preferred in pregnancy), fludrocortisone