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Pharmacology > Endocrine: adrenal Hormones > Flashcards

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
Q

long-term or excessive use of glucocorticoids will lead to______

A

cushingoid symptoms

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26
Q

does WBC count go up or down when on a steroid? and WHY

A

rises
b/c: glucocorticos cause a drop in blood levels of eosinophils, basophils, monocytes and lymphocytes and redistribute them to the lymphoid tissues

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27
Q

the longer acting the synthetic hormone is, the ____ glucocorticoid action on the system

A

greater

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28
Q

list the corticosteroids we use

*differentiate b/w glucocorticode and mineralcorticoide

A 
Betamethasone 
Cortisone 
Dexamesthasone 
Hydrocortisone 
Methylprednisolone 
Prednisolone
Prednisone
Triamcinolone 
Fludrocortisone--mineral
*everything else is glucocorticoid
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29
Q

list the two short acting glucocorticoids

A

hydrocortisone

cortisone

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30
Q

List the intermediate acting glucocorticos (4)

A

Prednisone
prednisolone
methylprednisone
triamcinolone

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31
Q

List the two long acting glucocorticoids

A

betamethasone

dexamethasone

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32
Q

Glucocorticoids have mainly ____ effects and Mineralcorticoids have ____ effectts

A

Glucos: anti-inflammatory MAINLY and very little salt retaining

Mineralcorticoids: MAINLY salt retaining activity and some anti-inflammatory

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33
Q

5 things glucocorticoids do to body

A
  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
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34
Q

glucos stimulate metabolism of what?

A

stim HEPATIC gluconeogenesis
stimulate lipolysis
stim mobilization of AAs

35
Q

how does glucocorticoids increase resistance to stress

A

by raising plasma glucose levels–this fights stress by giving body energy to fight off trauma, infection, bleeding or debilitating illnesses

36
Q

how does glucocorticoids alter blood cell levels in plasma (2)

A
  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
Q

how does glucocorticoids act as anti-inflammatory agents (3 ways)

A

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
Q

7 main/general indications for corticosteroids

A
  • 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
Q

autoimmune destruction of adrnal gland?

A

addisons disease

40
Q

how to tx primary addisons?

A

replace insufficent hormone!

  • hydrocortisone
  • Fludrocortisone–imp adjunct for NA and h20 balance
41
Q

which synthetic hormone is ID to natural cortisoL?

A

hydrocortisone

42
Q

what is the dosing like during the day for addisons PT

A

hydrocortisone is given about three times a day–following dinural release of cortisol

  • in am
  • once in early afternoon
43
Q

Most important mineralcorticocoid in body?

A

aldosterone

44
Q

which steroid is the only one used in tx of hyperaldosteronism

A

fludrocortisone

45
Q

can you suddenly discontinue steroids

A

NO

46
Q

what happens if you stop steroid tx all of a sudden and WHY

A

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
Q

since steroids are plasma bound–what happens after they enter the body

A

go right to LIVER for conjugation

48
Q

after absoprtion, steroids are _____ to ____ over 90%

A

bound to plasma proteins

49
Q

where are corticos metabolized

A

liver

50
Q

excretion?

A

kidneys

51
Q

once absorbed, what is the steroids effect on feedback mech of body

A

they exert negative feedback on the HPA— have potential to suppress hormone expression

52
Q

MC side eff of corticos and WHY

A

osteoporosis

WHY: beacuse steroids supress intestinal CA2+ absoprtion, inhibit bone formation and decrease sex hormone synthesis

53
Q

SE from corticos

A
  • 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
Q

abrupt discontinuation of steroids for a PT that has been on prolong dose will cause..?

A

acute adrenal insufficiency

55
Q

name the two inhibitors of the synthesis of adrenal steroids

A

ketoconazole

spironolactone

56
Q

when do we use adrenocorticoid inhibitors

A
  • in hyperaldosteronism–Conn’s Syndrome

- Cushing’s syndrome

57
Q

what is Conn Syndrome + s/s

A

adrenal gland is making too much aldosterone
*usually from exogenous tumor secretion aka adrenal tumor

s/s: hyPOk and HTN (very drug resistant)

58
Q

what is cushings syndrome

A

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
Q

MOA of ketoconazole

INDs?

A

inhibits all gonadal and steroid hormone synthesis

for Cushing syndrome

60
Q

indication for ketoconazole?

A

cushing syndrome

61
Q

indication for spironolactone?

A

Conn Syndrome aka hyperaldosteronism

62
Q

MOA for spironolactone in Conn Syndrome

A

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
Q

SE of spironolactone

A

HYPERK
gynecomastia
menstrual irregularities
skin rashes

64
Q

dexamethasone is used for the _____ of cushing syndrome

A

DIAGNOSIS

not tx

65
Q

general Indications for glucocorticoids (7)

A
  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
Q

which sterioud do we use for allg rhinitis?

A

GLUCO

*fluticasone

67
Q

what tx use for accerlation of lung maturation

A

Betamethasone or dexamethasone

68
Q

pharmkinetics for glucos

A

absoprtion: very readily PO
routes: PO, IM, IV,ntopical, inhalation intranasal

69
Q

factors to consider when dosing steroids

A

glucos vs mineralcorticoids
DOA
type of preparation
time of day when drug adminsitered

70
Q

when large doses of corticoids administered over ______weeks ______ of the _____ occurs

A

2 weeks
suppression
HPA Axsis

71
Q

if a PT needs to take long term steroids… what can help prevent suppression of HPA axsis

A

alteration in days of taking the steroid

letting the HPA axsis recover/function on days the hormone not taken

72
Q

two ways to administer steroids

A
  1. alternate day therapy– given every other am

2. declining dosae–therapeutic dose given… then taper off (dose Pak)

73
Q

are steroids bound

A

yes–plasma proteins
1. cortisol binding globulin or
2. albumin
over 90%

74
Q

List the steroids we can give ONLY IM

A

triamcinolone

75
Q

list the steroids we can give IV/IM

A 
dex
betameth
hydrocortisone
methylprednisolone
prednisolone
76
Q

list the steroids that are inhaled and nasal sprays

A 
beclomethasone
budesonide
ciclesonide
flunisolide 
fluticasone 
mometasone
traimcinolone
77
Q

PO steroids

A

cortisone
dexamethasone
methylprednisolone
prednisolone

78
Q

name steroids we give intra-articular

A

methylpred

triamcinolone

79
Q

list the steroids for topical prep

A

betamethasone
hydrocortisone
mometasone
triamcinolone

80
Q

what contributes to osteoporosis with long-term use of glucocorticoids?

A

Inhibition of CA absorption (inhib of bone formation)

81
Q

SE of corticosteroids in kids ?

A

can retard bone growth causing growth suppression

82
Q

tx for congenital adrenal hyperplasia

A

predisone

83
Q

which corticosteroid is indicated to give to a mom who is in preterm labor

A

Betamethasone

IM

Pharmacology (28 decks)

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