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Endocrine: adrenal Hormones Flashcards

1
Q

two types of corticosteroids secr from adrenal gland

A

Glucocorticoids

mineralcorticoids

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2
Q

what does adrenal gland secrete

A

corticosteroids–Aldosterone (mineralcortico), Cortisol (glucocorticoid)
androgens/estrogen

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3
Q

what do corticoids binds to? and where

A

intracellular cytoplasmic receptors IN target tissues

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4
Q

receptors for glucocortiodis and mineralcorticoids aka what are target tissues

A

gluco–all over the body

mineralcorticoids–excretory organs–kidney, colon, salivary glands, sweat glands

**BOTH found in the brain

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5
Q

effects of corticosteroids take how long?

A

hours-days

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6
Q

steroid hormones help regulate….. (6)

A
  • vital processes
  • prod of energy–CHO + protein metabolism (glucose)
  • extracellular fluid–reg salt/water balance
  • adaptation of body to external envi
  • growth and development
  • reproduction/lactation
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7
Q

what happens to hormones that are not used completely?

A

must be inactivated by enzymes in blood, intracellular spaces, liver, kidneys, OR target organs OR excreted

*in order for body to stay in homeostasis

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8
Q

what is the principal glucocorticoid?

A

cortisol

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9
Q

explain the pattern of production for cortisol

A

DINURAL– meaning peaks early in the morning and its followed by a decline early afternoon–then followed by a secondary small peak in late afternoon

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10
Q

most important therapeutic properties of glucocorticoids?

A

anti-inflammatory and immunosuppresive properties

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11
Q

what effect on plasma glucose levels does glucocorticoids have

A

increase it— so body has energy to combat stress caused by trauma, infection, bleeding, etc

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12
Q

glucocorticoid’s effects on levels of immune cells.. ex: eosins, basos, monocytes, lymphocytes?

A

decrease their circulating levels by redistributing then from circulation to the lymph tissue

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13
Q

what part of kidney does aldosterone act on and what is the end result

A

distal tubules and collecting ducts

RESULTS: INCRS reabsorbption of NA, H20 and bicarb and decrs reabsoprtion of: K,

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14
Q

aldosterone increases reabsoprtion of? aka promotes retention of____?

A

water, NA and bicarb

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15
Q

aldosterone decreases reabsoprtion of? promotes excretion of____

A

K and H+

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16
Q

what parts of the body can aldosterone increase NA reabsoprtino

A

kidneys
GI mucosa
sweat
salivary glands

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17
Q

s/s of elevated aldosterone levels

A 
alkalosis (b/c incr levels of NA+) 
hypoK 
retention of water and NA 
incr blood volume 
incr BP
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18
Q

zona glomerulosa releases what hormone

A

Mineralcorticoids—aldosterone

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19
Q

zona fasciculalata releases what hormone

A

glucocorticoids—cortisol

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20
Q

zona reticularis release what hormone

A

androgens–DHT

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21
Q

adrenal medulla rel what hormone

A

stress hormones—catecholamines–epi and norepi

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22
Q

Corticosteroids are activated by______ coming from _____

A

ACTH—-PG (AP)

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23
Q

how is ACTH regulated in body

A

hypothalamus

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24
Q

list the s/s for cushingoid symptoms

A
  • faitugue
  • weakness
  • edema
  • pot belly
  • buffalo hump
  • exces hair growth
  • mood and personality changes
  • psychological dependence
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25
long-term or excessive use of glucocorticoids will lead to______
cushingoid symptoms
26
does WBC count go up or down when on a steroid? and WHY
rises b/c: glucocorticos cause a drop in blood levels of eosinophils, basophils, monocytes and lymphocytes and redistribute them to the lymphoid tissues
27
the longer acting the synthetic hormone is, the ____ glucocorticoid action on the system
greater
28
list the corticosteroids we use | *differentiate b/w glucocorticode and mineralcorticoide
``` Betamethasone Cortisone Dexamesthasone Hydrocortisone Methylprednisolone Prednisolone Prednisone Triamcinolone Fludrocortisone--mineral *everything else is glucocorticoid ```
29
list the two short acting glucocorticoids
hydrocortisone | cortisone
30
List the intermediate acting glucocorticos (4)
Prednisone prednisolone methylprednisone triamcinolone
31
List the two long acting glucocorticoids
betamethasone | dexamethasone
32
Glucocorticoids have mainly ____ effects and Mineralcorticoids have ____ effectts
Glucos: anti-inflammatory MAINLY and very little salt retaining Mineralcorticoids: MAINLY salt retaining activity and some anti-inflammatory
33
5 things glucocorticoids do to body
1. promote normal intermediary metabolism 2. increase resistance to stress 3. alter blood cell levels in plasma (WBC) 4. possess anti-inflammatory action 5. affect on other systems of body
34
glucos stimulate metabolism of what?
stim HEPATIC gluconeogenesis stimulate lipolysis stim mobilization of AAs
35
how does glucocorticoids increase resistance to stress
by raising plasma glucose levels--this fights stress by giving body energy to fight off trauma, infection, bleeding or debilitating illnesses
36
how does glucocorticoids alter blood cell levels in plasma (2)
1. cause a shift of the WBC from blood into the lymphoid tissue--decreasig blood levels of eosinophils, basophils, and monocytes and lymphocytes--causing INCR WBC counts 2. cause increases in hemoglobin, RBCs, platelets, and PML (polymorphonuclear leukocytes)
37
how does glucocorticoids act as anti-inflammatory agents (3 ways)
promote immunosupression and anti-inflammation via: 1. lower circulating lymphocytes-->inhibit the ability of leukocytes and monocytes to respond to antigens 2. they inhibit phospholipase A2-->decr producting of proinflammatory cytokines****=results in decr inflammation 3. Inhibit histamine release via mast cells therefore stabilizing inflammation
38
7 main/general indications for corticosteroids
- allergic rxns/asthma - acceleration of lung development - relief of inflammatio: RA, autoimmune crises, acute inflammatory disorders - replacement tx for primary adrenocortical insuff (addisons) - DIAGNOSIS for adrenal hypercortisolim--cushing's syndrome - replacement tx for adrenal hyperplasia
39
autoimmune destruction of adrnal gland?
addisons disease
40
how to tx primary addisons?
replace insufficent hormone! * hydrocortisone * Fludrocortisone--imp adjunct for NA and h20 balance
41
which synthetic hormone is ID to natural cortisoL?
hydrocortisone
42
what is the dosing like during the day for addisons PT
hydrocortisone is given about three times a day--following dinural release of cortisol * in am * once in early afternoon
43
Most important mineralcorticocoid in body?
aldosterone
44
which steroid is the only one used in tx of hyperaldosteronism
fludrocortisone
45
can you suddenly discontinue steroids
NO
46
what happens if you stop steroid tx all of a sudden and WHY
PTs taking steroids long-term can have suppression of natural Hypothalmic-pituitary-axis (aka feedback mechanism) *stopping causes abrupt adrenal insufficiency---addisonian crisis---can be fatal
47
since steroids are plasma bound--what happens after they enter the body
go right to LIVER for conjugation
48
after absoprtion, steroids are _____ to ____ over 90%
bound to plasma proteins
49
where are corticos metabolized
liver
50
excretion?
kidneys
51
once absorbed, what is the steroids effect on feedback mech of body
they exert negative feedback on the HPA--- have potential to suppress hormone expression
52
MC side eff of corticos and WHY
osteoporosis | WHY: beacuse steroids supress intestinal CA2+ absoprtion, inhibit bone formation and decrease sex hormone synthesis
53
SE from corticos
- osteoporosis - HTN - Hyperglycemia-->can lead to DM 2 - glaucoma - centripetal distribution of fat--Cushing like syndrome - Peripheral edema - emotional disturbances: euphoria, depression PRLONG USE: -hyPOK -cataracts TOPICAL USE: purple striae, skin atrophy, ecchymosis
54
abrupt discontinuation of steroids for a PT that has been on prolong dose will cause..?
acute adrenal insufficiency
55
name the two inhibitors of the synthesis of adrenal steroids
ketoconazole | spironolactone
56
when do we use adrenocorticoid inhibitors
- in hyperaldosteronism--Conn's Syndrome | - Cushing's syndrome
57
what is Conn Syndrome + s/s
adrenal gland is making too much aldosterone *usually from exogenous tumor secretion aka adrenal tumor s/s: hyPOk and HTN (very drug resistant)
58
what is cushings syndrome
result of hypersecretion of cortisol due to increased secretion of ACTH from AP IS THE MC Cause * can have an adrenal tumor secreting cortisol (adenoma) * can have ectopic ACTH-producing tumor Exogenous soource: -long term high dose corticosteroid use
59
MOA of ketoconazole | INDs?
inhibits all gonadal and steroid hormone synthesis | for Cushing syndrome
60
indication for ketoconazole?
cushing syndrome
61
indication for spironolactone?
Conn Syndrome aka hyperaldosteronism
62
MOA for spironolactone in Conn Syndrome
competes with mineralcorticoid receptor--> inhibits NA reabsorption by kidney----and SPARES K**** * Antagonizes aldosterone and testosterone synthesis* - --why it can be good for women with hurtuism
63
SE of spironolactone
HYPERK gynecomastia menstrual irregularities skin rashes
64
dexamethasone is used for the _____ of cushing syndrome
DIAGNOSIS | not tx
65
general Indications for glucocorticoids (7)
1. replacement therapy for primary adrenocortical insufficiency (Addisons) 2. replacement therpy for secondary or teritary adrenoinsuff 3. diagnosis for cushing syndrome (dexamethasone test) 4. replacement therapy for congenital adrenal hyperplasia 5. Relief of inflammatory s/s--RA, inflamm skin conds, asthma, IBD, NOT A CURE THO 6. allergies--allg rhinitis, drug serum and transfusion allg rxns 7. fetal lung maturation
66
which sterioud do we use for allg rhinitis?
GLUCO | *fluticasone
67
what tx use for accerlation of lung maturation
Betamethasone or dexamethasone
68
pharmkinetics for glucos
absoprtion: very readily PO routes: PO, IM, IV,ntopical, inhalation intranasal
69
factors to consider when dosing steroids
glucos vs mineralcorticoids DOA type of preparation time of day when drug adminsitered
70
when large doses of corticoids administered over ______weeks ______ of the _____ occurs
2 weeks suppression HPA Axsis
71
if a PT needs to take long term steroids... what can help prevent suppression of HPA axsis
alteration in days of taking the steroid | letting the HPA axsis recover/function on days the hormone not taken
72
two ways to administer steroids
1. alternate day therapy-- given every other am | 2. declining dosae--therapeutic dose given... then taper off (dose Pak)
73
are steroids bound
yes--plasma proteins 1. cortisol binding globulin or 2. albumin over 90%
74
List the steroids we can give ONLY IM
triamcinolone
75
list the steroids we can give IV/IM
``` dex betameth hydrocortisone methylprednisolone prednisolone ```
76
list the steroids that are inhaled and nasal sprays
``` beclomethasone budesonide ciclesonide flunisolide fluticasone mometasone traimcinolone ```
77
PO steroids
cortisone dexamethasone methylprednisolone prednisolone
78
name steroids we give intra-articular
methylpred | triamcinolone
79
list the steroids for topical prep
betamethasone hydrocortisone mometasone triamcinolone
80
what contributes to osteoporosis with long-term use of glucocorticoids?
Inhibition of CA absorption (inhib of bone formation)
81
SE of corticosteroids in kids ?
can retard bone growth causing growth suppression
82
tx for congenital adrenal hyperplasia
predisone
83
which corticosteroid is indicated to give to a mom who is in preterm labor
Betamethasone | IM

Pharmacology (28 decks)

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