Glucocorticoids and mineralocorticoids

Question 1

Corticosteriods

Answer 1

Adrenal gland steriods
Made in zona reticularis (17)

Question 2

Glucocorticoid

Answer 2

Endo and Exo glucocorticoid
Made in Zona fasciculata (3,17,11)

Question 3

MineralCorticoid

Answer 3

endo Aldosterone
Made in zona reticularis (17)
Exo mineral corticoid
Made in zona Glomerulosa ( 3, 21 , 11, aldosterone systhesis)

Question 4

Glucocorticoid Biosynthesis

Answer 4

Cholesterol (P450SCC) to Pregnenolone
Pregnenolone (3beta and sigma 5) to progesterone
progesterone (17 alpha) 17 hydroxyproesterone
17 hydroxyproesterone (21 beta) to 11 deoxycortisol
11 deoxycortisol (11-beta) cortisol

Question 5

Cortisol effects Deficiency

Answer 5

1. hypoglycemia
2. Weight loss
3. hypotesnsion
4. anemia
5. weakness
6. long immune response and fever

Question 6

Cortisol effect excess

Answer 6

cushing diagram
1. insulin resistance
2. stria in skin
3. central fat and weight gain
4. mild hypertesnsion
5. weakness and bone weakness
6. immunocompromised

Question 7

Aldoesterone deficiency

Answer 7

1. hypotension
2. Hyponatremia with ADH
3. hyperkalemia

Question 8

Aldoesterone deficiency

Answer 8

1. hypotension
2. Hyponatremia with ADH
3. hyperkalemia

Question 9

Aldosterone Excess

Answer 9

1.hypertension
2.hypernatremia
3.hypokalemia

Question 10

Cortisol Indications

Answer 10

1. Adrenal insufficiency
2. congenital hyperplasia
3. diagnosis of cushing syndrom
4. infam disorders ( osteoarthritis, UC crohn, Rhinitis, Asthma)
5. immun disorders( Arthritis, MS, Organ transplant)

Question 11

Addison disease

Answer 11

MOA: aldosterone is out of control (not by HPA axis )
Indicaitons: hypoglycemia, hypotension, weight loss, weakness

Question 12

Congenital adreanl disorder

Question 13

Dex suppresion test

Question 14

HPA suppresion

Question 15

Cortilsol Contraindication

Answer 15

1. systemic infections
2. diabetes
3. peptic ulcer
4. osteoporosis
5. HF and HTN
6. Cataracts and glaucoma
7. Pregnacny
8. CNS

Question 16

Cortisol interaction

Answer 16

1. Nsaid
2. diabetic agents
3. drug effect K levels
4. antiHTN meds
5. CYP inducers
6. CYP inhibitors
7. Live vaccines

Question 17

weak Gluco and mineral

Answer 17

Hydro 1 anti inflame 1 na-retaining potency
Cortisone .5 and .5

Question 18

Potent gluco and mineral

Answer 18

Fludrocortisone 10 ant inflam 125 na retention

Question 19

Potent gluco and weak mineral

Answer 19

Prednisolone 4 and 1
methyprednisolone 5 and .5
anti inflam and na retention

Question 20

Potent gluco and no mineral

Answer 20

triamcinolone 5 0
betamethasone 25 0
dexamethasone 25 0
anti inflam and na retention

Question 21

Fomulation of corticosteroids

Answer 21

PO only for cortisone, fludrocortisone and pred
inhalation for triamcinolone
PO and inject only for methylprednisolone

Question 22

How to treat Parenteral Gluco

Answer 22

Hydrocortisone, methylpred, triam, betamethasone, dexameth
use: for emergencies (hyrdocortisone drug of choice)

Question 23

Oral gluco

Answer 23

Hydrocortisone, pred, methylpred, dexa
Use: adrenal insufficiency, Infam, soild organ transplant, chemo

Question 24

Triamcinolone

Answer 24

MOA: same as cortisol
Use:Asthma, allergies, COPD
AD: cortisol ones, Oropharyngeal candidiasis, Throat irritation

Question 25

Topical Glucocorticoids

Answer 25

Hydocorti, triam, beta, dexa
MOA: same as cortisal
AD: same as cortisol
Notes: safest for chronic use