DD6 Glucocorticoids Flashcards
Do mineralcorticoids or glucocorticoids have inflammatory action?
Glucocorticoids
-steroidal anti inflammatory drug
3 modes of regulation by HPA axis?
- Diurnal rhythm
- Negative feedback
- Stress
- overrides (-) feedback→ Anterior pituitary release ACTH → cortisol release (glucocorticoid)
How does negative feedback regulate HPA axis?
a) Circulating corticosteroids → regulates (neg feedback) on hypothalamus and pituitary → ↓ ACTH release + steroidogenesis
How does stress regulate HPA axis?
a) Stress ( ie: Hemorrhage, severe infection, surgery, hypoglycemia, cold, pain, fear (anything stressful really)) → override (-) feedback
What are glucocorticoid (cortisol) metabolic effects on carbohydrate?
increase gluconeogenesis
increase blood glucose
increase insulin
What are glucocorticoid (cortisol) metabolic effects on protein?
decrease protein synthesis
increase aa
net transfer of AA from muscle to bone
What are glucocorticoid (cortisol) metabolic effects on fat?
increase lipolysis
increase free fatty acids
What are mineralocorticoid (aldosterone) effects on kidney?
increase Na reabsorption
increase blood volume
increase BP
What is the most commonly used glucocorticoid for steroid burst therapy? 2nd?
1st: prednisone
2nd: methylpresnisone
What is a potent anti-inflammatory glucocorticoid used for treating cerebral edema?
Dexamethasone (decadron)
What is the most potent anti inflammatory glucocorticoid agent?
Dexamethasone (decadron)
Iatrogenic Cushing’s syndrome
caused by too much glucocorticoids:
diabetes-like state (hyperglycemia),
protein wasting (muscle),
lipid deposition (weight gain)
Mineralocorticoid effects
Salt and water retention
edema
increased blood pressure,
hypokalemia
Virchows triad
3 factors that promote thrombosis (blot clot)
- Abnormal blood flow
- Endothelial injury
- Hypercoagulability
Left sided system emboli
what does it affect?
arterial
-can affect any organ (mostly leg or brain)
Right sided system emboli
what does it affect?
Venous
- lungs (PE)
How is septic shock different from Cardiogenic and hypovolemic?
Septic shock = immensely elevated inflammatory mediators
increased blood flow vs not enough flow.
Infarcts
(areas of necrosis) caused by ischemia.
White infarcts
arterial blockage
-heart, kidney, spleen
Red infarcts
venous blockage
- lung, liver, intestine
Single or duel blood supply:
White infarcts
Red infarcts
White: Single blood supply
Red: duel blood supply
- harder to infarct
DIC
disseminated intravascular coagulation
clotting and bleeding at same time
Congestion
pathologic accumulation of blood
Hemorrhage
blood outside vasculature
