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Pharm Block 4 > Corticosteroids > Flashcards

Corticosteroids Flashcards

1
Q

When are ACTH and cortisol mostly secreted

A

morning when you wake up

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2
Q

bind to cytoplasmic receptor

A

Corticosteroids

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3
Q

acts as transcription factor, regulates the transcription leading to mRNA and protein synthesis

A

GRE - glucocorticoid response elements

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4
Q

4 things to remember about corticosteroids

A

1) give in the morning
2) give as single dose in morning
3) takes 14 days to work
4) make sure to taper and takes 1 month for adrenals to recover

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5
Q

1) reduced synthesis of COX2 and cytokines
2) inhibit fxn of macrophage and antigen presenting cells
3) increase lymphocyte apoptosis
4) inhibit neutrophil migration to tissue
5) inhibit phospholipase A2
6) decrease capillary permeability

A

physiological effects of glucocorticoids

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6
Q

1) stimulate glycogen deposition in liver
2) gluconeogenesis
3) decrease peripheral utilization of glucose

Results = hyperglycemia and decreased insulin sensitivity

A

carbohydrate metabolism effects of glucocorticoids

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7
Q

1) redistribution of body fat

2) moon face, buffalo hump, fish mouth, thin limbs, lemon on stick appearance

A

lipid metabolism effects of glucocorticoids

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8
Q

protein breakdown
muscle wasting
tanning of skin
healing delayed

A

protein metabolism effect of glucocorticoids

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9
Q

sodium and water retention

edema and hypertension on prolonged use

A

electrolyte and water effects of corticosteroids

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10
Q

decrease calcium levels in blood by inhibiting calcium absorption from gut and increasing its renal excretion

prolong use causes osteoporosis

A

calcium effects of corticosteroids

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11
Q

responsible for HTN associated with cushings

A

cortisols mineralocorticoids

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12
Q

hypertension and worsening of congestive symptoms of heart failure due to sodium and water retention

A

CVS effects of corticosteroids

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13
Q

inhibit prostaglandin synthesis, increased gastric acid synthesis
CI in peptic ulcer

A

GIT effects of corticosteroids

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14
Q

hyperpigmentation, ACTH increase, hypotension, hyperkalemia, increase blood eosinophils count and fasting hypoglycemia

A

Addison’s dz

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15
Q

treatment for Addisons

A

Hydrocortisone + fludrocortisone

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16
Q

female newborn with ambiguous external genitalia
dehydration
hypotension

A

21 beta hydroxylase def

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17
Q

treatment for 21 beta hydroxylase def

A

fludrocortisone + cortisol

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18
Q

dexamethasone test results

1) blood cortisol suppression >50% means inhibition

A

pituitary cushings syndrome

19
Q

dexamethasone test results

1) blood cortisol suppression < 50% means no inhibition
2) ACTH increase

A

lung cancer

20
Q

dexamethasone test results

1) blood cortisol suppression < 50% means no inhibition
2) ACTH decrease

A

adrenal tumor

21
Q

short acting glucocorticoids

t half less than 12 hrs

A

hydrocortisone

prednisolone

22
Q

used in emergency

equal glucose and mineral corticoid activity

A

Hydrocortisone

23
Q

active drug
4x more potent
single dose in morning mimics normal circadian rhythm of cortisol

A

prednisolone

24
Q

intermediate acting

t half 12-36 hrs

A

triamcinolone

25
Q

no mineralocorticoid activity

no salt retaining

A

triamcinolone

26
Q

long acting

t half 36 hrs

A

dexamethasone

27
Q

no mineralocorticoid activity
never given as replacement
used in hospital only
not used long term

A

dexamethasone

28
Q

inhalation steroid preparations

A

fluticasone
beclomethasone
budesonide
triamcinolone

29
Q

topical steroid preparations

A

betamethasone
triamcinolone
hydrocortisone

30
Q

Cushing features

A 
cataract 
ulcer
skin thinner
hypertension/hirsutism
infection
necrosis of femoral head
glycosuria
osteoporosis/obesity
immunosuppression
diabetes
31
Q

CI for glucocorticoids

A 
peptic ulcer
heart dz
HTN with heart failure
varicella
TB
psychosis
diabetes
osteoporosis
glaucoma
32
Q

adrenal suppression
Osteoporosis
femur head avascular osteonecrosis
muscle wasting

A

some ADR of glucocorticoids

33
Q

Uses for glucocorticoids

A

1) adrenal insufficiency
2) congenital adrenal hyperplasia
3) asthma
4) collagen vascular
5) ocular dz
6) lung maturation
7) skin dz
8) chemotherapy
9) cushings
10) cerebral edema
11) anti inflammatory

34
Q

abrupt stoppage of glucocorticoids therapy after prolonged use causing:

1) flaring up of underlying dz
2) with drawl sx - fever, myalgia, malaise, athralgia
3) acute adrenal insufficiency

low dose should be used and tapered slowly without abrupt stopping to avoid ADR

A

HPA axis suppression

35
Q

Inhibits CYP450 (desmolase), which catalyze rate limiting step conversion of cholesterol to pregnenolone

A

Aminoglutethimide

36
Q

Reduces biosynthesis of all physiological steroids

Used to decrease hypersecretion of cortisol in px with Cushing’s syndrome

Used to reduce estrogen production in tx with great cancer with dexamethasone

A

Aminoglutethimide

37
Q

Inhibits CYP450 11 hydroxylase enzymes

A

Metyrapone

38
Q

Used to test adrenal fxn (insufficiency)

  • if pit and adrenal are normal will cause increase ACTH and atrophy of adrenal cortex
  • tumor suppresses ACTH and atrophy of adrenal cortex (not caused by adrenal tumor)

Only adrenocorticoid antagonist that can be used for cushings in pregnacy

A

Metyrapone

39
Q

Antifungal
Inhibits steroid synthesis in high doses except 21 hydroxylase

Treatment for Cushing’s syndrome

A

Ketoconazole

40
Q

Antiprogestin activity
High doses block glucocorticoid receptors
Mainly used as contraceptive, abortificient (+ misoprostol)

A

Mifepristone

41
Q

Major minerocorticoid

Secretion controlled by aldosterone and RAAS (increase BP)

Acts on renal tubule cells to increase reabsorption of Na, bicarb, H2O in exchange for K excretion

A

Aldosterone

42
Q

Primarily used for replacement therapy after adrenalectomy or for primary and secondary adrenocortical insufficiency

A

Fludrocortisone

43
Q

ADR: hypokalemia and congestive heart failure due to volume overload

A

Fludrocortisone

44
Q

Aldosterone receptor antagonist - inhibits 17 alpha hydroxylase (competes with DHT)

Treats: primary hyperaldosteronism and baldness in men due to excessive androgen

A

Spironolactone

Pharm Block 4 (18 decks)

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