Corticosteroids (Iszard)

Question 1

What are the two main effects of glucocorticoids?

Answer 1

1. anti-inflammatory effect
2. immunosupressive effect

Question 2

Glucocorticoid agonist

Answer 2

Short-acting: hydrocortisone (cortisol) and cortisol
Intermediate-acting: prednisone, prednisolone, methylprednisolone, and triamcinolone
Long-acting: betamethasone and dexamethasone

Question 3

Mineralocorticoids agonists

Answer 3

Fludrocortisone; indicated in adrenal insufficiency (Addison’s disease)

Question 4

Glucocorticoid antagonist

Answer 4

mifepristone; also indicated in medical abortions; very rarely for Cushing’s syndrome

Question 5

Mineralocorticoid antagonist

Answer 5

spironolactone and eplerenone (more specific); K+ sparing diuretic; most common adverse effect is HYPERkalemia

Question 6

The mineralocorticoid receptor has equal affinity for what two hormones?

Answer 6

aldosterone and cortisol

Question 7

MOA of 11-beta HSD2?

Answer 7

converts active cortisol to inactive cortisone

Question 8

MOA 11-beta HSD1?

Answer 8

converts inactive cortisone to active cortisol

Question 9

Treatment for Addison’s disease?

Answer 9

combination of glucocorticoid (hydrocortisone) and mineralocorticoid (fludrocortisone)

Question 10

Treatment for congenital adrenal hyperplasia?

Answer 10

combination of glucocorticoid (hydrocortisone) and mineralocorticoid (fludrocortisone)

Question 11

Botton line message for corticosteroid use?

Answer 11

cannot be given chronically without the risk for adverse events (mainly immunosuppression); use lowest dose for the shortest possible duration

Question 12

Corticosteroid use is problematic in which patient populations?

Answer 12

Immunocompromised (HIV/AIDs)
Psychiatric conditions
Osteoporosis
Infections and peptic ulcers

Question 13

Glycyrrhizin

Answer 13

licorice root extract; inhibitor of 11B-HSD2; cortisol stays active; Na+ and H2O retention; increase K+ loss; increase in BP

Question 14

Pramlintide

Answer 14

anti-diabetic medication; always used with insulin

Question 15

short to medium-acting <12 hours corticosteroid drugs

Answer 15

hydrocortisone (cortisol) and cortisol

Question 16

intermediate-acting 12-36 hours corticosteroid drugs

Answer 16

prednisone
prednisolone
methylprednisolone
triamcinolone

Question 17

long-acting >36 hours corticosteroid drugs

Answer 17

betamethasone and dexamethasone

Question 18

Importance of dose-tapering

Answer 18

allows for HPA recovery; w/ chronic use there will be adrenal atrophy; watch for adrenal withdrawal syndrome

Question 19

What are the 3 ways to test for HPA axis integrity?

Answer 19

morning serum cortisol test
ACTH test
CRH test

Question 20

Mitotane

Answer 20

can treat cancer of the adrenal glands (adrenal cortical carcinoma)

Question 21

Ketaconazole

Answer 21

synthesis inhibitor; blocks fungal and human CYP450 enzymes; indicated in inhibition of steroid hormone synthesis; watch for hepatic dysfunction