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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
Q

When should high-dose dexamethasone suppression test be performed?

A

after a low dose test

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26
Q

What are the 3 general steps of high-dose dexamethasone test?

A

measure AM baseline cortisol

administer dexamethasone PM

measure cortisol in AM

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27
Q

What is your presumed dx with the following results from high-dose dexamethasone suppression test?

  • extreme suppression of cortisol
A

normal

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28
Q

What is your presumed dx with the following results from high-dose dexamethasone suppression test?

-cortisol 50% suppressed

A

Cushings disease

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29
Q

What is your presumed dx with the following results from high-dose dexamethasone suppression test?

-cortisol unchanged

A

Cushing’s syndrome

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30
Q

A patient presents with the following S/S… what do you presume?

  • weakness, anorexia, weight loss
  • hyperpigmentation
  • hypoglycemia, salt craving
  • hypotension, GI problems
A

Addison’s Disease

31
Q

a patient presents with: circulatory collapse, dehydration, vomiting, hyperkalemia.

May be fatal

What do you suspect and what is the cause?

A

addisonian crisis, acute adrenal insufficiency

32
Q

Which glucocorticoid is used for replacement and has weak anti-inflammatory effects?

A

hydrocortisone

33
Q

Which class of glucocorticoids are used for anti-inflammatory properties only?

A

new synthetics

34
Q

What drug is a mineralcorticoid that causes increased sodium and water retention?

A

fludrocortisone

35
Q

Fludrocortisone can be combined with what drug if replacement is needed?

A

glucocorticoid

36
Q

Which glucocorticoid is cortisol?

A

hyrocortisone

37
Q

hydrocortisone/cortisone has what indication?

A

replacement therapy for adrenal insufficiency

38
Q

what drug must be converted to hydrocortisone in the liver for activation?

A

cortisone

39
Q

Does cortisone have higher or lower potency than hydrocortisone?

A

lower

40
Q

_______ must be converted to prednisolone in the _______ to be active…

A

Prednisone converted in liver

41
Q

Do prednisone/prednisolone have more GC or MC effects?

A

GC

42
Q

What is the most commonly prescribed oral GC?

A

prednisone

43
Q

What two drugs have virtually no MC activity?

A

Triamcinolone, methylprednisolone

44
Q

Most new GC drugs are similar to…

A

triamcinolone and methylprednisolone

45
Q

Which GCs have no salt retaining properties, high anti-inflammatory properties, and are long acting?

A

betamethasone, dexamethasone

46
Q

Which GCs have no salt retaining properties, moderate anti-inflammatory properties, and are intermediate acting?

A

methylpredisolone, triamcinolone

47
Q

Which GCs have moderate anti-inflammatory properties, low salt-retaining, and are intermediate acting?

A

prednisone, prednisolone

48
Q

Which GCs have low/equal anti-inflammatory and low salt retaining properties. They are short acting?

A

hydrocortisone, cortisone

49
Q

What preparation of steroids should be used for long-term therapy and replacement?

A

oral

50
Q

what preparation of steroids should be used in emergencies or for depot administration?

A

IM

51
Q

what preparation of steroids should be used for asthma and rhinitis?

A

inhalation, intranasal

52
Q

Potent topicals should only be administered where?

A

thick skin

53
Q

What prevents absorption of topical steroids?

A

insoluble

54
Q

What would increase systemic absorption of topical steroids? (2)

A

skin damage/thin skin

repeat application

55
Q

replacement in chronic adrenal insufficiency can be achieved with…

A

GCs or GC/MCs

56
Q

For patients with stress or infection, how should dosing be adjusted? Why?

A

increase dose, acute insufficiency is life threatening

57
Q

Are adrenocorticoids curative in RA? what effect do they have?

A

resolve sxs, not curative

58
Q

What are 4 major therapeutic guidelines for steroid administration?

A

only as long as necessary, lowet effective dose, local admin, give on alternate days.

59
Q

Chornic steroid tx may leave the HPA subnormal for how long?

A

months

60
Q

Is short term (1-2 weeks) steroid therapy likely to cause serious problems?

A

no

61
Q

Corticosteroids have few side effects with actue therapy. What two factors can cause adverse effects?

A

long-term, high dose therapy

62
Q

What are 4 major adverse effects to corticosteroid administration?

A

infx, hyperglycemia, CNS sxs, osteoporosis

63
Q

What is the most damaging and therapeutically limiting effect of corticosteroids?

A

osteoporosis

64
Q

What percent of patients using chronic steroids have a fracture due to therapy?

A

30-50%

65
Q

> 1-2 weeks of high dose CS therapy can cause…

A

HPA depression

66
Q

Abrupt cessation of corticosteroids can cause…

A

acute adrenal insufficiency

67
Q

T/F: CS administration can cause cushing-like side effects

A

true

68
Q

If a patient has adrenal insufficiency, is there a contraindication to using corticosteroids?

A

no

69
Q

In the absence of adrenal insufficiency, what are 6 C/Is for corticosteroids?

A 
infx
poor DM
osteoporosis
CVD/HTN
Immunosuppression
Childhood/pregnancy
70
Q

This orally active antigungal also inhibits steroidogenesis at high doses…

A

ketoconazole

71
Q

What is the 1st line drug for pre-operative Cushing’s patients?

A

ketoconazole

72
Q

If a cushing’s patient is pregnant, can you give ketoconazole?

A

no

73
Q

What GC receptor antagonist also blocks progesterone receptors and offers immediate hypercortisolemia relief?

A

nifepristone

74
Q

Which MC receptor antagonist also blocks some androgen receptors and can be used for hyperaldosteronism and hirsutism?

A

Spironolactone

Pharmacology II (23 decks)

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