Endocrine: Corticosteroids Flashcards
What are the main main reasons to give glucocorticoids? (4)
Anti-inflammatory
-allergies, immunological disorders
Establish diagnosis of Cushings
Treat adrenal insufficiency
Treat congenital adrenal hyperplasia
MOA of prednisone?
Glucocorticoid agonist
-blocks NFkB, LOX and COX to decrease production of all inflammatory cytokines, leukotrienes, and prostaglandins
MOA of fludrocortisone?
Mineralocorticoid agonist
-increases salt and water resorption
MOA of mifepristone?
Glucocorticoid receptor antagonist
MOA of spironolactone/eplerenone?
Mineralocorticoid antagonist
-blocks actions of mineralcorticoids to increase Na+ excretion, stop K+ excretion=decrease in BP
MOA of ketoconazole?
blocks fungal CYP450 and inhibits steroid hormone synthesis
Why are corticosteroids considered bad to give chronically?
Adverse effects pop up
- immunosuppresion
- insulin resistance (diabetes)
- osteoporosis
- Iatragenic cushings
What are the short acting glucocorticoids?
Hydrocortisone
Cortisone
What are the intermediate acting glucocorticoids?
Prednisone
Prednisolone
Methylprednisolone
Triamcinolone
What are the long acting glucocorticoids?
Betamethasone
Dexamethasone
What substances inhibit 11B-HSD2 and cause more active steroid production?
Glycyrrhizin (licorice)
Carbenoxolone
=more cortisol=higher BP
How should you take patients off of steroids?
Taper them
How should you take patients off of steroids?
Taper them
-abrupt withdrawl is bad news bears
Clinical indication for fludrocortisone?
Adrenal insufficiency (Addison’s disease)
What drug can be used for the diagnosis of adrenal insufficiency and Cushings?
Metyrapone
