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pharm II, exam 3 > Corticosteroids > Flashcards

Corticosteroids Flashcards

1
Q

Mineralocorticoids are regulated by

A
  • angiotensin II
  • K+
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2
Q

Glucocorticoids-cortisol is regulated by

A
  • ACTH stimulates release
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3
Q

effect of Glucocorticoids on carbs, protein, and fat

A
  • increase circulating levels of glucose, free fatty acids and amino acids
  • antagonizes insulin
  • redistribution of body fat (extremities -> central)
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4
Q

effect of Glucocorticoids on cardiovascular function

A
  • increase vascular responsiveness to sympathetic stimulation
    • inhibits catecholatmine reuptake
  • some Na+ and H2O retention
  • increase CO
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5
Q

effect of Glucocorticoids on endocrine

  • CRH
  • GH
  • TSH
  • LH
  • epi
A
  • negative feedback on CRH -> Decrease ACTH
  • decreases
    • GH
    • TSH
    • LH -> inhibits reproduction
    • increase Epinephrine production from adrenal medulla
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6
Q

glucocorticoid effect on vitamin D and parathyroid

A
  • vit D -> decreased Ca2+ deposition into bone
  • increases parathyroid hormone -> increase Ca2+ loss from bone
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7
Q

glucocorticoid effect on immune system

A
  • immunosuppressive
    • ​decrease WBC #
  • blocks all steps in inflammation
    • ​blocks heat, erythema, swelling, tenderness
    • decreases PLA2, COX2, cytokines and IgE responses
  • suppression of wound healing
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8
Q

glucocorticoid effect on CNS

A
  • mood elevation
  • insomnia
  • anxiety
  • depression
  • psychosis
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9
Q

glucocorticoid effect on GI

A

associated with peptid ulcer development

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10
Q

What is Cushings

A
  • glucocorticoid excess
  • cause
    • ACTH excess - tumor
    • cortisol excess
      • tumor
      • exogenous glucocorticoids
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11
Q

List common signs of Cushings

A
  • Buffalo hump
  • thinning of skin
  • thin arms and legs
  • euphoria
  • moon face with red cheeks
  • increased abdominal fat
  • easy bruising
  • poor wound healing
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12
Q

symptoms of Addison’s disease

A
  • adrenocorticol insufficiency
    • weight loss
    • hyperpigmentation
    • hypotension
    • hypoglycemia, salt craving
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13
Q

What is addisonian crisis

A
  • acute adrenal insufficiency
    • circulatory collapse, dehydration, vomiting, hyperkalemia
    • fatal
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14
Q

What is the one Mineralocorticoid medication

A
  • Fludrocortisone
    • increase Na+/H2O retention
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15
Q

two main uses for glucocroticoids medications

A
  • replacement
  • anti-inflammation
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16
Q

Function of Hydrocortisone

A
  • aka cortisol
  • exhibits both mineralocorticoids and glucocorticoid properties equally
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17
Q

indications for Hydrocortisone (Cortef)

A
  • replacement therapy for adrenal insufficiency
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18
Q

Function of Cortisone (Cortone)

A
  • exhibits both mineralocorticoid and glucocorticoid properties equally
  • cortisone must first be converted to hydrocortisone in liver in order to be active
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19
Q

indications for Cortisone (Cortone)

A

replacement therapy for adrenal insufficiency

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20
Q

List the three drugs used for replacement therapy

A
  • Glucocorticoid:
    • Hydrocortisone (Cortef® )
    • Cortisone (Cortone®)
  • Mineralocorticoid:
    • Fludrocortisone (generic)
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21
Q

List the Anti-inflammatory drugs

A
  • Prednisone (Meticorten®)
  • Prednisolone (Delta-Cortef®)
  • Methylprednisolone (Medrol®)
  • Triamcinolone (Aristocort®, Kenalog®)
  • Betamethasone (Celestone®)
  • Dexamethasone (Decadron®)
  • Fluticasone (Flovent®, Flonase®)
22
Q

Differentiate between Prednisone and Prednisolone

A

prednisone must first be converted to prednisolone in the liver in order to be active

23
Q

effects of Prednisone and Prednisolone

A

more glucocorticoid effects than mineralocorticoid

24
Q

Effects of Triamcinolone, and Methylprednisolone Dexamethasone

A
  • high glucorcorticoid activity
  • virtually no mineralocorticoid activity
25
Q

list education for patients taking topical glucocorticoids

A
  • more potent topicals -> thick skin only
  • skin damage or thin skin -> increases systemic absorption
  • repeated application -> depot effect
26
Q

preparations of glucocorticoids

A
  • oral: long term therapy
  • injections
  • inhalation
  • topical
27
Q

indications of Fludrocortisone

A
  • Has both mineralocorticoid and glucocorticoid activity
    • More significant mineralocorticoid effects: used as an aldosterone agonist
  • Given with glucocorticoids in the treatment of adrenocortical insufficiency when more mineralocorticoid effects are needed.
28
Q

How is patient with a chronic adrenal insufficiency (Addisons) treated

A
  • tx with glucocorticoid alone or with a glucocorticoid + mineralocorticoid
29
Q

dosage of replacement therapy in patient with a chronic adrenal insufficiency (Addisons) during times of stress or infection

A
  • 2x for minor stress
  • up to 10 x for major stress
30
Q

Inhaled steroids have become first line treatment for

A

asthma

  • used inconjunction with B2 agonist
31
Q

Therapeutic guidelines for giving corticosteroids

A
  • lowest effective dose
  • use locally whenever possible
  • give on alternate days
    • decreasses suppression of HPA axis
32
Q

chronic tx of corticosteroids can have what effect on HPA axis

A
  • can cause suppression of HPA axis
  • *short term therapy (1-2 weeks) is not likely to cause serious problem
33
Q

List the adverse effects of corticosteroid use

A
  1. Infections
    1. may mask symptoms
    2. more susceptible to serious infection
  2. hyperglycemia
    1. may unmask diabetes
  3. CNS
  4. osteoporosis
  5. Cushingoid effects
34
Q

List the adverse effects of corticosteroid use on CNS

A
  • restlessness, insomina, increase appetite
    • seen even with acute treatments
35
Q

abrupt cessation of corticosteroids tx can cause

A
  • acute adrenal insufficiency
  • do gradual withdrawal
36
Q

patients who are chronically taking corticosteroids can get what during times of stress

A

stress can cause adrenal crisis

37
Q

list the 4 main signs of Cushingoid effects

A
  • acne
  • truncal obestiy
  • buffalo hump
  • moon face
38
Q

contraindications to taking corticosteroids in adrenal insufficiency

A

NONE

39
Q

contraindications to taking corticosteroids

A
  • infection
  • diabetes
  • osteoporosis
  • heart disease or HTN
  • immunosuppressed
  • childhood
  • pregnancy
40
Q

list the things to monitor when patient is on corticosteroids

A
  • hyperglycemia
  • Na+ retension with edema or HTN
  • hypokalemia
  • peptid ulcer
  • osteoporosis
  • infections
  • growth and development in children
41
Q

all agents that inhibit corticosteroids can precipitate what

A

acute adrenal insufficiency

42
Q

List the corticosteroid synthesis inhibitors

A
  • Aminoglutethimide
  • Ketoconazole
43
Q

MOA of Aminoglutethimide

A
  • blocks adrenal and gonadal steroid synthesis
44
Q

Aminoglutethimide must be given with what to suppress ACTH

A

corticosteroids

45
Q

MOA of Ketoconazole

A
  • antifungal that inhibits steroid synthesis at high doses
  • non-selective
46
Q

List the glucocorticoid receptor antagonist

A
  • Mifepristone
47
Q

MOA of Mifepristone

A
  • antagonist of glucocorticoid and progesterone receptors
48
Q

use of Mifepristone

A

for inoperable cushings patients

49
Q

MOA of spironolactone

A
  • Mineralocorticoid (and some androgen) receptor antagonist
  • potassium sparing
50
Q

use of spironolactone

A
  • hyperaldosteronism
  • hirsutism

pharm II, exam 3 (8 decks)

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