Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm II > Corticosteroids > Flashcards

Corticosteroids Flashcards

1
Q

local cortical hormones in the blood leads to what two things?

A

stimulates the hypothalamus to secrete more CRH and stimulates the anterior pituitary to produce more ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what does a stimulated anterior pituitary producing more ACTH lead to?

A

leads to more ACTH secretion which stimulates the adrenal cortex to release cortical hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what does releasing cortical hormones lead to? two downstream effects of this?

A

increase of cortical hormones in the blood which inhibits the hypothalamus (little CRH released) and the anterior pituitary is inhibited

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

with less ACTH being secreted what is inhibited and ultimately leads to what?

A

leads to inhibition of adrenal cortex and ultimately leads to low cortical hormones in the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

3 layers of the adrenal cortex from outermost to innermost?

A

zona glomerulosa
zona fasiculata
zona reticularis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

3 layers of the adrenal cortex (outer to inner) and their products?

A

glomerulosa: mineralcorticoids (aldosterone)
fasiculata: glucocorticoids (cortisol)
reticularis: sex steroids (DHEA, T, E, Pg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

glucocorticoids helps regulate what?

A

metabolism of proteins, CHO and lipids

promote gluconeogenesis in the liver which leads to increased blood sugar levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

precursor of all steroid hormones?

A

progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

where is cortisol synthesized from?

A

progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the main hormone secreted by the adrenals?

A

cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

in what two circumstances is cortisol released?

A

in response to stress & when serum glucose levels drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

two ways cortisol increases blood sugar levels?

A

gluconeogenesis and glycogenolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

name for cortisol when it is prescribed?

A

hydrocortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how does cortisol affect insulin?

A

counteracts insulin and leads to hyperglycemia and ultimately leads to insulin resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how do glucocorticoids affect the immune system and its cells specifically?

A

causes increase in # of circulating PMNs

decrease circulating lymphocytes, eosinophils, basophils, monocytes and MOs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how do glucocorticoids affect prostaglandins and leukotrienes?

A

decrease both and lead to lower levels of inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

b/c of glucocorticoids effects on WBCs what condition can they be useful in treating?

A

leukemia b/c help decrease the overall count

also increase Hgb and RBC counts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

7 indications for glucocorticoid use?

A 
inflammatory or allergic conditions
reactive airway dz
allergies
arthritis
AI conditions
replacement tx for Addison's dz
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

glucocorticoid effects on immature bone cells? effects with high doses on mature bone cells?

A

immature: essential for differentiation
mature: increased apoptosis, decreased proliferation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

glucocorticoid effects on immature cartilage cells? effects with high doses on mature cartilage cells?

A

immature: essential for differentiation
mature: reduced collage and proteoglycan synth, reduced proliferation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

glucocorticoid effects on immature muscle cells? effects with high doses on mature muscle cells?

A

immature: early differentiation
mature: increased proteolysis, atrophy, decrease in GF expression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

glucocorticoid effects on immature synovium/skin cells? effects with high doses on mature synovium/skin cells?

A

immature: not essential for differentiation
mature: decreased inflam signaling, reduced collagen synth, reduced proliferation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

glucocorticoid effects on immature adipose cells? effects with high doses on mature adipose cells?

A

immature: differentiation
mature: increased lipoprotein lipase activity, hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what can inhaled steroids be used to tx?

A

asthma but also for pts w/emphysema and chronic bronchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

why are inhaled steroids preferred over oral for airway conditions?

A

b/c lowered SEs and enhanced effectiveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

when using topical steroids, with pts w/dry skin what is a better vehicle to use? with oily skin or seborreha?

A

dry skin: do better w/ointments or pastes

oily/seborrhea: creams, lotions or shake lotions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

when are weaker topical steroids used?

A

whenever possible for use in thin-skinned and sensitive areas such as armpit, groin, perianal area and breast folds

28
Q

when are moderate strength topical steroids used?

A

atopic dermatitis, nummular eczema, lichen sclerosis of the vulva, scabies and severe dermatitis

29
Q

when are stronger strength topical steroids used?

A

psoriasis, lichen planus, discoid lupus, severely chapped feet, lichen simplex chronicus, severe poison ivy, alopecia areata, nummular eczema and severe atopic derm in adults

30
Q

what is tachyphylaxis and how can you prevent it? how quickly can tachyphylaxis develop?

A

tachy: rapid decrease in response to a drug over a relatively short time period
can prevent by prescribing its use to one week on and one week off routine
can develop after a single initial dose! mech not understood…

31
Q

with drugs affecting the NS, what is the mech behind tachyphylaxis?

A

felt to be depletion of neurotransmitter that is involved in the action of the drug

32
Q

mech behind glucocorticoid tachyphylaxis?

A

not well understood but postulated that it is dt drug tolerance whereby the reduced responsiveness is dt cellular mechanisms

33
Q

6 mechanisms of tolerance?

A
  1. change in receptors
  2. loss of receptors
  3. exhaustion of mediators
  4. increased metabolic degradation
  5. physiological adaptation
  6. active extrusion of drug from cells
34
Q

rectal preparations of glucocorticoids can be used to tx what?

A

hemorrhoids, anal pruritis, proctitis, UC

35
Q

active ingredient in preparation H?

A

phenylephrine! vasoconstrictor

36
Q

concerns with prolonged use of higher concentration glucocorticoids?

A

allergic rxn
not proven to be safe in PG or breast feeding
may increase blood sugar in diabetics
may exacerbate glaucoma, myasthenia gravis, osteoporosis
may increase hypothyroidism or cirrhosis
may lead to increased gastric acid levels
may cause slower wound healing and increased infxns
may worsen acute psychosis
may cause wt gain, swelling, acne, sweating, increased hair

37
Q

ocular glucocorticoids can be used how?

A

tx allergic conjunctivitis, corneal ulcers, corneal injuries, iritis, keratitis, optic neuritis, after ophthalmologic procedures such as keratoplasty

38
Q

when are IV steroids used?

A

severe acute allergic response, moderate to severe cases of reactive airway dz, spinal cord trauma, shock, Addisonian crisis, bacterial meningitis, cerebral edema, septic shock, blood transfusion rxns, idiopathic or immune thrombocytopenia purpura

39
Q

mechanism of anti-inflammation of glucocorticoid drugs?

A

inhibit phospholipase A2 which blocks the release of arachadonic acid which is the precursor of prostaglandins and blocks release of leukotrienes from membrane bound phospholipids
also suppress histamine and kinin activity

40
Q

adverse effects of glucocorticoids?

A 
reduced resistance to infxns
hyperglycemia
possibly DM
severe bone loss
avascular necrosis
cataracts
myopathy
thinning of skin
diminished wound healing
easy bruising
insomnia 
mental status changes
increased appetite leading to wt gain from excess calories as well as salt and water retention
41
Q

causes of avascular necrosis?

A

poor bone healing post-fracture, corticosteroid use, long term EtOH use and abuse, radiation therapy, sickle cell anemia

42
Q

where are glucocorticoids absorbed? metabolized?

A

absorbed from the GI

metabolized by the liver’s microsomal oxidizing enzymes

43
Q

short acting 8-12 hrs glucocorticoid? intermediate acting 18-36 hrs?
long acting 24-72 hrs?

A

short acting: hydrocortisone, cortisone

intermediate: prednisone, pednisolone, methylprednisoone, triamcinolone
long: paramethasone, dexamethasone, betamethasone

44
Q

order of 4 most used glucocorticoid medications ranked from least potent to most?

A

hydrocortisone (1)
prednisone (4)
dexamethasone (30)
betamethasone (35)

45
Q

what is an important rule to remember in regards to glucocorticoids and mineralcorticoids?

A

the stronger the glucocorticoid (corticosteroid) the weaker the mineralcorticoid effect
the reverse is also true
ex: prednisone, a lower potency corticosteroid, has a greater mineralcorticoid effect than beclomethasone which is a more potent corticosteroid and therefore has a lower mineralcorticoid effect

46
Q

what can abrupt discontinuation of glucocorticoids cause?

A

acute adrenal insufficiency syndrome aka Addisonian crisis which can be lethal

47
Q

how to manage an Addisonian crisis?

A

immediate IV of 100 mg hydrocortisone followed by 100-200 g hydrocortisone
fluid admin 1000 mL 0.9% NaCl during 1st 60 mins
further fluid admin guided by central venous P
monitor

48
Q

ssxs of adrenal insufficiency aka Addison’s dz?

A 
chronic, worsening fatigue
muscle weakness
loss of appetite
wt loss
hyperpigmentation
N/V
diarrhea
low BP
irritability and depression
craving for salty foods dt salt loss
hypoglycemia
H/A
sweating 
irregular or absent menstrual periods
49
Q

Addisonian crisis sxs?

A 
severe lethargy
severe V/D often resulting in dehydration
low BP
confusion
hyponatremia and hypoglycemia
LOC
convulsions
if untreated it is fatal
50
Q

class of hydrocortisone/cortef? preferred for treating what? MOA?

A

class: glucocorticoid/corticosteroid
preferred for: cortisol replacement therapy
MOA: affects gene transcription to either stimulate or repress protein production

51
Q

how to administer hydrocortisone/cortef? chemically identical to what? DOA?

A

administer PO, IV, IM
chemically identical to naturally occurring cortisol
short DOA

52
Q

class of prednisone/deltasone? preferred for treating what? MOA?

A

class: glucocorticoid/corticosteroid
preferred for treating moderate to severe allergic rxns, important drug for leukemia rxns
MOA: affects gene transcription to either stimulate or suppress protein production

53
Q

how to rx prednisone/deltasone? DOA?

A

take PO

intermediate DOA

54
Q

class of dexamethasone/decadron? useful to tx what? MOA?

A

class: fluroinated corticosteroid
extremely potent anti-inflammatory, also useful in IV form for reducing ICP
MOA: affects gene transcription to either stimulate or repress protein production

55
Q

how to rx dexamethasone/decadron? DOA?

A

PO/IV/topical/inhaled
long DOA
minimal mineralcorticoid effects

56
Q

class of triamcinolone inhaler/azmacort? indications? MOA? how to rx?

A

class: corticosteroid
indications: asthma, COPD, not indicated for tx acute asthma attack once it has already begun
MOA: diminishes inflammation of bronchial wall, affects gene transcription and alters protein production
take orally via inhaler

57
Q

SEs of triamcinolone inhaler/azmacort?

A

thrust, sore throat, nosebleeds, increased coughing, H/A, runny nose

58
Q

what is beclomethasone/qvar or vancenase? what can it be used for?

A

pro-drug of the corticosteroid beclometasone
can be used for prophylaxis asthma attack as an inhaler or to tx rhinitis, hay fever and sinusitis if used as a nasal spray

59
Q

what is the outer most section of the adrenal cortex? what does it produce? what are it’s hormones responsible for?

A

glomerulosa –> produces mineralcorticoids such as aldosterone which are responsible for regulating intravascular volume and BP (cause retention of Na, bicarb and H2O and decrease reabsorption of K)

60
Q

in what dz will you see decreased levels of aldosterone? in what dz will you see increased levels?

A

decreased in Addison’s dz

increased in Conn’s syndrome

61
Q

class of fludrocoritone/florinef? indications? MOA?

A

class: halogenated glucocorticoid/mineralcorticoid agonist
indications: mineralcorticoid replacement for pts w/Addison’s dz and other cases of hyponatremia
MOA: Na retention, reduction of Na loss to urine at renal tubular cells

62
Q

how to rx fludrocortisone/florinef? DOA? what is not an indication of it? SEs?

A 
take PO, potent mineralcorticoid
DOA: long 
minimal glucocorticoid effects 
no indicated as an anti-inflammatory 
SEs: Na retention, edema, HTN, rash, N/V
63
Q

innermost layer of the adrenal cortex? what does it produce? examples?

A

zona reticularis

produces sex hormones such as DHEA, T, E, Pg

64
Q

when can it be useful to supplement with DHEA?

A

osteoporosis, depression, SLE, pts undergoing skin grafting

65
Q

when should DHEA use be decreased or discontinued?

A

when pts experience acne or hirsutism

66
Q

when is DHEA supplementation c/i?

A

in pts w/PMHx of sex hormone responsive CAs such as breast, uterine, ovarian or prostate CA
risk vs benefits of supplementation w/DHEA should also be considered in women with (+) FHx of estrogen sensitive CAs and in men w/benign prostatic hypertrophy or a FHx of CaP

Pharm II (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions