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Pharmacology II-Exam 2 > Endocrine-Adrenal Cortex > Flashcards

Endocrine-Adrenal Cortex Flashcards

1
Q

What hormones does the adrenal cortex/gland secrete?

A

Corticosteroids derived from cholesterol like mineralocorticoids & glucocorticoids

Androgens

Estrogen

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2
Q

What is an example of a mineralocorticoid

A

Aldosterone

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3
Q

Role of aldosterone

A

Fluid & electrolyte balance by increase Na reabsorption and increasing K+, Ca+ & Mg+ excretion

Increases activity of NaK pump

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4
Q

Aldosterone effects on the CV and MS system

A

Na & H2o retention may increase BP & CO

Muscle weakness due to K+ & Ca+ excretion

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5
Q

Aldosterone has no

A

Glucocorticoid effect

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6
Q

An example of a glucocorticoid is

A

Cortisol

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7
Q

Glucocorticoid-cortisol metabolism…

A

Stimulates gluconeogenesis through protein catabolism

Carbohydrate storage as glycogen

Mobilization of fatty acids from adipose w/redistrtibution

Oxidation of fatty acids

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8
Q

Glucocorticoid-cortisol balances

A

Fluid & electrolytes by diuresis, increasing GFR, RBF, Na reabsorption & K+ excretion (can inhibit anti-diuretic)

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9
Q

Glucocorticoid-cortisol effects on endocrine

A

Increases secretion of GH and synthesis & effects of epi

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10
Q

Glucocorticoid-cortisol CV effects

A

High levels can induce HTN & increased responsiveness to vasopressors

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11
Q

Glucocorticoid-cortisol MS effects

A

Muscle wasting, bone loss, & reduced bone remodeling

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12
Q

Glucocorticoid-cortisol CNS effects

A

Increased excitability, mood changes, dementia, & cognitive depression

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13
Q

Glucocorticoid-cortisol hematologic effects

A

Increases serum HGB & RBC

Decreases lymphocytes, eosinophils, monocytes& basophils

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14
Q

Glucocorticoid-cortisol on anti-inflammatory effects

A

Stabilizes lysosomal membranes

Stops leukocyte migration & inhibits recruitment of neurophils

Decreases capillary permeability & edema

Inhibition of hypersensitivity & rejection response

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15
Q

Glucocorticoid-cortisol on eyes & hair/skin

A

Cataracts & increased IOP

Alopecia & poor wound healing, purport & purple striae

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16
Q

Cortisol Pharmacokinetics

A

Hypothalamus (CRH) …anterior pituitary (ACTH)…adrenal cortex (cortisol)

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17
Q

Cortisol is released

A

Episodically

Follows sleep-wake cycle

At max just before waking

Lowest 8-10 hrs after waking

Stress-induced release

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18
Q

Cortisol has

A

Permissive effects, giving target cell permission to interact w/another “something”

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19
Q

With cortisol, major surgery will

A

Increase pro inflammatory cytokines, CRH & ACTH

Cortisol secretion increases 5-10x normal

Normal function may malfunction temporarily after surgery

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20
Q

Cortisol in moderately invasive surgery

A

May increase 304x normal

May remain elevated until post day 7

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21
Q

Cortisol in minor surgery

A

May double

Often to baseline after surgery

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22
Q

Primary Adrenal Insufficiency

A

Localized adrenal gland problem

Autoimmune

Carcinoma

TB

Chronic=Addisnos

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23
Q

Secondary Adrenal Insufficiency

A

Pituitary gland not stimulating adrenal glands enough

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24
Q

What is an adrenal crisis

A

Fever, syncope, convulsions, hypoglycemia, hyponatremia, severe vomiting & diarrhea

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25
Q

Addisons disease looks like

A

Hyperpigmentation

Low BP
Weakness
Wt loss
N/V/D
Constipation
ABD pain
Vitiligo

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26
Q

Structural differences or modifications of corticosteroids affect

A

Glucocorticoid/Mineralocorticoid activity

Metabolism

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27
Q

MOA of corticosteroid

A

Bind cytoplasmic receptors

Stimulate/inhibit DNA transcription

Regulates protein synthesis

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28
Q

Mineralocorticoid receptors are located in

A

Renal tubules

Colon

Salivary glands

Hippocampus

Cause distal tubular reabsorption of Na & excretion of K+

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29
Q

Glucocorticoid receptors are located

A

Widely distributed

Cause anti-inflammatory & immunosuppressive response

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30
Q

Examples of synthetic glucocorticoids

A

Prednisolone, Prednisone, methylprednisolone, betamethasoone, dexamethasone & triamcinolone

31
Q

MOA of synthetic glucocorticoids

A

Decrease inflammation

Prevent activation & migration of immune cells

32
Q

Betamethasone & Dexamethasone have

A

No mineralocorticoid activity

33
Q

Clinical uses of synthetic glucocorticoids

A

Adrenal insufficiency

Allergic reactions

Asthma

34
Q

In adrenal insufficiency, synthetic glucocorticoids…

A

Cortisol & cortisone replacement

Fluid & electrolyte replacement

35
Q

In allergic reactions, synthetic glucocorticoids have…

A

Anti-inflammatory effects

Delayed therapeutic effects

36
Q

In asthma, synthetic glucocorticoids are..

A

Often 1st line regimen

Improve lung function & prevent exacerbation

Direct inhibition of inflammatory cell mechanisms

37
Q

With cerebral edema, synthetic glucocorticoids…

A

Indirectly improve ICP

Dexamethasone IV

Should be AVOIDED in severe head injury or hemorrhage

38
Q

With aspiration pneumonitis, synthetic glucocorticoids

A

Is controversial

39
Q

With arthritis & lumbar disc disease, synthetic glucocorticoids…

A

Decrease inflammation & edema

Improves symptom flares

40
Q

Synthetic glucocorticoids are also used for

A

Ulcerative colitis

MG

Leukemia

Cutaneous disorders

Ocular inflammation

41
Q

Clinical uses of synthetic glucocorticoids in the ICU

A

Shock

Cardiac Arrest

Respiratory Distress Syndrome

42
Q

Adrenal insufficiency contributes to

A

Vasodilation

43
Q

In shock, synthetic glucocorticoids increase _____ from endothelial glucocorticoid receptor activation

A

SVR

44
Q

In cardiac arrest, synthetic glucocorticoids will

A

Lower circulating cortisol, vasoplegia & myocardial dysfunction & may improve survival

45
Q

In respiratory distress syndrome, synthetic glucocorticoids…

A

Dexamethasone improves outcomes in neonates

46
Q

Synthetic glucocorticoids use for anesthesia include

A

Organ transplant (for immunosuppression & decreases risk for rejection

Antiemesis (dexamethasone given after induction to prevent PONV; often given w/ondansetron or droperidol

Analgesia (peripheral inhibition along cyclooxyrgenase & lipoxygenase pathways; preemptive or intraoperative dexamethasone & betamethasone decreases post pain)

47
Q

What happens with long term steroid administration, severe adrenal illness & HPA axis suppression?

A

Reduced cortisol stress response

Risk acute adrenal crisis

Should continue corticosteroids perioperatively

48
Q

Symptoms related to synthetic glucocorticoids (anesthesia problems)

A

Fluid resistant HOTN

Changes in consciousness & cognitive decline

N/V & Abd pain

Hypoglycemia

Hyponatremia &hyperkalemia

Persistent fever

49
Q

HPA axis suppression is affected by

A

Steroid dose & duration

50
Q

Low-No suppression should be treated by

A

Prednisone 5mg/day

or therapy <3 weeks

Glucocorticoid supplementation is not required

51
Q

If there is assumption of HPA axis suppression, treat with

A

Prednisone >20mg/day & more than 3 weeks

Will have symptoms of Cushing syndrome

Glucocorticoid supplementation administered depending on invasiveness of surgery

52
Q

How to treat unknown HPA axis suppression

A

5-20mg/day prednisone or prolonged therapy may have variable HPA axis suppression

High dose inhaled fluticasone, topical steroids & intra-articular or spinal injections over week-months at high risk of HPA inhibition

53
Q

How to assess HPA suppression

A

serum cortisol >10mcg/dl- no inhibition

5-10mcg/dl-some inhibition likely

54
Q

What are some rationales for stress dose steroids

A

Permissive effect on vascular tone (enhanced vascular reactivity & inhibition of prostacyclin (PGI2)

Catecholamine Levels (cortisol involved in catecholamine synthesis & mediates release from sympathetic neurons

Myocardial contractility (improves stroke work index)

55
Q

Hydrocortisone (Solu-cortef) is used to treat

A

Acute adrenal crisis 7 Chronic AI

1st line for stress dose steroid replacement

Inflammation

Status Asthmaticus

56
Q

Hydrocortisone (Solu-cortef) has what activity?

A

Glucocorticoid & mineralocorticoid activity

57
Q

Hydrocortisone (Solu-cortef) is _______acting and lasts_______

A

Short acting

8-12 hour duration

58
Q

Hydrocortisone (Solu-cortef) dose for minor surgery

A

25mg IV

59
Q

Hydrocortisone (Solu-cortef) dose for moderate surgical stress

A

50-75mg IV

60
Q

Hydrocortisone (Solu-cortef) dose for major surgery

A

100mg

61
Q

What consideration should you take when a person has normal mineralocorticoid activity and needs replacement therapy

A

Consider switching to methylprednisolone

62
Q

Dexamethasone (decadron) is used to treat

A

Inflammation & allergic conditions

Immunosuppression

Cerebral edema

Shock

Antiemesis

Analgesia

63
Q

Dexamethasone (decadron) is a derivative of

A

Prednisolone

64
Q

Which medication is a potent glucocorticoid with minimal to no mineralocorticoid activity

A

Dexamethasone (decadron)

65
Q

Dexamethasone (decadron) is ______acting, with a a duration of______

A

Long acting

3-5 days

66
Q

As an antiemetic, Dexamethasone (decadron) should be dosed at…

A

4-12 mg IV (dependent on PONV risk)

67
Q

As an analgesia, what is the dose of Dexamethasone (decadron)

A

4-10mg for analgesia & prolong duration of regional anesthetic

68
Q

Dexamethasone (decadron) can be given post-intubation or for positional _______ & should be dosed at_______

A

Laryngeal edema

10-16mg IV

69
Q

In neurosurgery, Dexamethasone (decadron) can be given for cerebral edema at what dose?

A

10mg IV

70
Q

Adverse effects of corticosteroids

A

HPA axis suppression (long term tx)

Electrolyte & metabolic changes such as hypokalemia, metabolic alkalosis, edema, wt gain, hyperglycemia & fat redistribution

Osteoporosis

Peptic ulcer disease

Skeletal muscle myopathy

CNS dysfunction (neuroses, psychoses & cataracts)

Lymphocytopenia, increase HCT & inhibition of growth

71
Q

Larger doses of _____may attenuate cortisol response to surgical stress

A

Opioids

72
Q

________can cause minimal suppression of stress-induced endocrine response

A

Volatile Anesthetics

73
Q

_______inhibits cortisol synthesis & can cause adrenal insufficiency in critically ill patients

A

Etomidate

74
Q

_________can decrease cortisol release & may decrease preoperative complication

A

Regional Anesthesia

Pharmacology II-Exam 2 (5 decks)

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