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Pharmacology II > Endocrine: Corticosteroids > Flashcards

Endocrine: Corticosteroids Flashcards

1
Q

Newer glucocorticoid drugs: (4)

A

Methylprednisolone, triamcinolone, betamethasone, dexamethasone

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2
Q

mineralcorticoid drugs: (2)

A

Aldosterone, fludrocortisone

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3
Q

Glucocorticoids with equal GC and MC properties… (2)

A

hydrocortisone, cortisone

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4
Q

Glucocorticoids with more GC effects than MC effects…

A

prednisone, prednisolone

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5
Q

Mineralcorticoids are regulated by…

A

ATII and K+

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6
Q

What effects do mineralcorticoids have (2)?

A

increase sodium and water retention

increase excretion of potassium

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7
Q

What stimulates the release of glucocorticoids?

A

ACTH

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8
Q

What effects do GCs have on CHOs, Prot, and fat?

A

increase glucose, FFAs, AAs

antagonize insulin

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9
Q

GCs cause body fat to be redistributed where?

A

central

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10
Q

Glucocorticoids have what effect on vascular responsiveness to SNS stimulation?

A

increase SNS responsiveness

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11
Q

The increased vascular responsiveness to SNS upon GC administration has what effect on catecholamines?

A

inhibits uptake = increase serum conc.

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12
Q

What effect does GC administration have on sodium and water?

A

some retention (less than MCs)

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13
Q

What effect do GCs have on cardiac output?

A

increased

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14
Q

Negative feedback on CRH and ACTH by cortisol results in a decrease of which 4 hormones?

A

GH, TSH, LH, Vit. D

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15
Q

How do GCs effect bone concentration of calcium?

A

Vit. D inhibition = decreased deposition

Increase PTH secretion = increase Ca loss from bone

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16
Q

What two substances increase in the presence of glucocorticoids?

A

PTH and Epi

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17
Q

What are three major effects of glucocorticoids on the immune system?

A

immunosuppression, block inflammation, suppression of wound healing

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18
Q

What drug has the following CNS effects?

  • mood elevation
  • insomnia
  • anxiety
  • depression
  • psychosis?
A

GCs

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19
Q

Cushings disease is most commonly caused by…

A

pituitary tumor

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20
Q

Cushing’s disease or syndrome are both characterized by…

A

ACTH or cortisol excess

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21
Q

What is the most common cause of glucocorticoid excess?

A

exogenous glucocorticoid administration

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22
Q

Adrenocortical insuffieciency is characterized by a lack of…

A

corticosteroids

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23
Q

What are three causes of adrenocortical insufficiency?

A

addison’s disease, adrenal or pituitary malfunction

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24
Q

Cushings is diagnosed with what test?

A

high-dose dexamethasone suppression test

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25
When should high-dose dexamethasone suppression test be performed?
after a low dose test
26
What are the 3 general steps of high-dose dexamethasone test?
measure AM baseline cortisol administer dexamethasone PM measure cortisol in AM
27
What is your presumed dx with the following results from high-dose dexamethasone suppression test? - extreme suppression of cortisol
normal
28
What is your presumed dx with the following results from high-dose dexamethasone suppression test? -cortisol 50% suppressed
Cushings disease
29
What is your presumed dx with the following results from high-dose dexamethasone suppression test? -cortisol unchanged
Cushing's syndrome
30
A patient presents with the following S/S... what do you presume? - weakness, anorexia, weight loss - hyperpigmentation - hypoglycemia, salt craving - hypotension, GI problems
Addison's Disease
31
a patient presents with: circulatory collapse, dehydration, vomiting, hyperkalemia. May be fatal What do you suspect and what is the cause?
addisonian crisis, acute adrenal insufficiency
32
Which glucocorticoid is used for replacement and has weak anti-inflammatory effects?
hydrocortisone
33
Which class of glucocorticoids are used for anti-inflammatory properties only?
new synthetics
34
What drug is a mineralcorticoid that causes increased sodium and water retention?
fludrocortisone
35
Fludrocortisone can be combined with what drug if replacement is needed?
glucocorticoid
36
Which glucocorticoid is cortisol?
hyrocortisone
37
hydrocortisone/cortisone has what indication?
replacement therapy for adrenal insufficiency
38
what drug must be converted to hydrocortisone in the liver for activation?
cortisone
39
Does cortisone have higher or lower potency than hydrocortisone?
lower
40
_______ must be converted to prednisolone in the _______ to be active...
Prednisone converted in liver
41
Do prednisone/prednisolone have more GC or MC effects?
GC
42
What is the most commonly prescribed oral GC?
prednisone
43
What two drugs have virtually no MC activity?
Triamcinolone, methylprednisolone
44
Most new GC drugs are similar to...
triamcinolone and methylprednisolone
45
Which GCs have no salt retaining properties, high anti-inflammatory properties, and are long acting?
betamethasone, dexamethasone
46
Which GCs have no salt retaining properties, moderate anti-inflammatory properties, and are intermediate acting?
methylpredisolone, triamcinolone
47
Which GCs have moderate anti-inflammatory properties, low salt-retaining, and are intermediate acting?
prednisone, prednisolone
48
Which GCs have low/equal anti-inflammatory and low salt retaining properties. They are short acting?
hydrocortisone, cortisone
49
What preparation of steroids should be used for long-term therapy and replacement?
oral
50
what preparation of steroids should be used in emergencies or for depot administration?
IM
51
what preparation of steroids should be used for asthma and rhinitis?
inhalation, intranasal
52
Potent topicals should only be administered where?
thick skin
53
What prevents absorption of topical steroids?
insoluble
54
What would increase systemic absorption of topical steroids? (2)
skin damage/thin skin | repeat application
55
replacement in chronic adrenal insufficiency can be achieved with...
GCs or GC/MCs
56
For patients with stress or infection, how should dosing be adjusted? Why?
increase dose, acute insufficiency is life threatening
57
Are adrenocorticoids curative in RA? what effect do they have?
resolve sxs, not curative
58
What are 4 major therapeutic guidelines for steroid administration?
only as long as necessary, lowet effective dose, local admin, give on alternate days.
59
Chornic steroid tx may leave the HPA subnormal for how long?
months
60
Is short term (1-2 weeks) steroid therapy likely to cause serious problems?
no
61
Corticosteroids have few side effects with actue therapy. What two factors can cause adverse effects?
long-term, high dose therapy
62
What are 4 major adverse effects to corticosteroid administration?
infx, hyperglycemia, CNS sxs, osteoporosis
63
What is the most damaging and therapeutically limiting effect of corticosteroids?
osteoporosis
64
What percent of patients using chronic steroids have a fracture due to therapy?
30-50%
65
> 1-2 weeks of high dose CS therapy can cause...
HPA depression
66
Abrupt cessation of corticosteroids can cause...
acute adrenal insufficiency
67
T/F: CS administration can cause cushing-like side effects
true
68
If a patient has adrenal insufficiency, is there a contraindication to using corticosteroids?
no
69
In the absence of adrenal insufficiency, what are 6 C/Is for corticosteroids?
``` infx poor DM osteoporosis CVD/HTN Immunosuppression Childhood/pregnancy ```
70
This orally active antigungal also inhibits steroidogenesis at high doses...
ketoconazole
71
What is the 1st line drug for pre-operative Cushing's patients?
ketoconazole
72
If a cushing's patient is pregnant, can you give ketoconazole?
no
73
What GC receptor antagonist also blocks progesterone receptors and offers immediate hypercortisolemia relief?
nifepristone
74
Which MC receptor antagonist also blocks some androgen receptors and can be used for hyperaldosteronism and hirsutism?
Spironolactone

Pharmacology II (23 decks)

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