Corticosteroids

Question 1

Explain the CRF-axis

Answer 1

HT→ Corticotropin-Releasing Factor (CRF)
AP→ ACTH
Adrenal Cortex→ Glucocorticoids (ex: cortisol) & Mineralocorticoids (ex: aldosterone)

Question 2

Endogenous aldosterone secretion primarily controlled by?

Answer 2

Endogenous aldosterone secretion primarily controlled by angiotensin II receptor activation on the adrenal cortex; secondary
control by ACTH from pituitary

Question 3

Adrenal cortex disorders of hyper-activity

Answer 3

• Hyper-activity
– Cushing’s syndrome
– Hyperaldosteronism

Question 4

Adrenal cortex disorders of hypo-activity

Answer 4

• Hypo-activity
– Addison’s disease
– Hypothalamic/pituitary issue

Question 5

Corticorelin

1. ) Drug class
2. ) Will see ↑ in ?

Answer 5

1. ) CRF

2. ) ↑ in ACTH, cortisol, and aldosterone

Question 6

Cosyntropin

1. ) Drug class
2. ) Will see ↑ in ?

Answer 6

1. ) ACTH
2. ) ↑ in cortisol and aldosterone
   - possible ↓ in CRF (due to negative feedback loop)

Question 7

1. ) Primary adrenal insufficiency consists of lesions of ?

2. ) Treatment

Answer 7

1. ) Adrenal cortex

2. ) Treat with GR and MR agonist (b/c cortex can’t make either steroid)

Question 8

1. ) Secondary adrenal insufficiency consists of lesions of ?
2. ) Treatment

Answer 8

1. ) pituitary/hypothalmus

2. ) Treat with GR agonist

Question 9

Therapeutic uses of Glucocorticoids?

Answer 9

-acute/chronic inflammation
-immunosupression
→ prevent organ transplant rejection
-replacement therapy in adrenal insufficiency
-hematologic disorder

Question 10

Betamethasone

Answer 10

Glucocorticoid Receptor Agonist

Question 11

Budesonide

Answer 11

Glucocorticoid Receptor Agonist

Question 12

Clobetasol

Answer 12

Glucocorticoid Receptor Agonist

Question 13

Cortisone

Answer 13

Glucocorticoid Receptor Agonist

Question 14

Dexamethasone

Answer 14

Glucocorticoid Receptor Agonist

Question 15

Fluticasone

Answer 15

Glucocorticoid Receptor Agonist

Question 16

Hydrocortisone

Answer 16

Glucocorticoid Receptor Agonist

Question 17

Methylprednisolone

Answer 17

Glucocorticoid Receptor Agonist

Question 18

Mometasone

Answer 18

Glucocorticoid Receptor Agonist

Question 19

Prednisolone /Prednisone

Answer 19

Glucocorticoid Receptor Agonist

Question 20

Triamcinolone

Answer 20

Glucocorticoid Receptor Agonist

Question 21

ADRs of Glucocorticoid Receptor Agonist

Answer 21

• Hyperglycemia (due to its ↑ GH effect)
• immunosupression
• growth retardation (eventually ↑ GH will diminish)
• HPA axis supression

Question 22

HPA Axis Suppression

Answer 22

-After about one week of (systemic) GR agonist therapy, endogenous cortisol production is suppressed via negative feedback inhibition
– Takes 2-3 days for HPA axis to turn back on (SO for those 2-3 you don’t have cortisol and you could die)

***Why its important to taper

Question 23

Mifepristone

Drug classes?

Answer 23

1. )
   - Glucocorticoid Receptor Antagonist
   - Progesterone receptor antagonist

Question 24

Fludrocortisone

1. ) Drug class?
2. )Mimics?
3. ) Indication?

Answer 24

1. ) Mineralcorticoid Receptor Agonist
2. ) mimics aldosterone
3. ) primary adrenal insufficieny

Question 25

Aldosterone

MOA?

Answer 25

Binds to mineralocorticoid receptor → INCREASE # of Na channels → more Na/H20 reabsorption and K+ efflux

Question 26

What drugs antagonize Aldosterone?

Answer 26

• Spironolactone

- Eplerenone