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Endo Final Pharm > Glucocorticoids DSA > Flashcards

Glucocorticoids DSA Flashcards

1
Q

What are the 3 reasons why we would use glucocorticoids in endocrine practice?

A
  1. Figure out cause of Cushing’s syndrome
  2. Treat adrenal insufficiency
  3. Treat CAH
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2
Q

What does it mean to use supraphysiologic dose of glucocorticoids and when do we use do this?

A

When we treat adrenal insufficiency or CAH, we are resorting the patient’s level to physiological normal. When we give above normal, or supraphysiolgic, we are treating inflammatory, allergic and immunological disorders.

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3
Q

What are the 5 corticosteroid receptors?

A

AR, ER, PR, GR, MR

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4
Q

What is the weak androgen made in the adrenal gland and what is it converted to in males and females?

A

DHEA to testosterone and estrogen

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5
Q

What does 11 beta HSD2 and HSD1 do?

A

1 converts cortisone to cortisol

2 converts cortisol to cortisone

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6
Q

What is the big time effect of inhibiting or decreasing the activity of 11 beta HSD2?

A

You will have a bunch of cortisol, which will stimulate the heck out of the MR.

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7
Q

What are the 2 known inhibitors of 11 beta HSD2?

A

Glycyrrhizin (licorice) and carbenoxolone

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8
Q

Big time carb metabolism effect of glucocorticoids?

A

Provide glucose! They stimulate the heck out of gluconeogenesis

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9
Q

Lipid metabolism effect of glucocorticoids?

A

Break down fat to provide FFA and glycerol into gluconeogenesis

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10
Q

Protein metabolism effect of glucocorticoids?

A

Break down protein or inhibit the synthesis of it to use those AAs to make glucose

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11
Q

Basically, glucocorticoids are anti what then when it comes to metabolism?

A

Anti insulin

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12
Q

What is the most important therapeutic effects of glucocorticoids?

A

Anti inflammatory and immunosuppressant

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13
Q

What is central to the anti inflammatory effect of glucocorticoids and what is the mechanism of action?

A

Decreased production of prostaglandins and leukotrienes because of inhibition of phospholipase A2.

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14
Q

Besides its central role, what are 4 anti inflammatory functions of glucocorticoids?

A
  1. Decreased production of cytokines
  2. Decreased production and increased apoptosis of immune cells
  3. Decreased migration of macrophages and neutrophils
  4. Decreased cell adhesion molecules
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15
Q

What do we give for primary adrenal insufficiency?

A

Combo of glucocorticoids and mineralcorticoids

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16
Q

What do we give to treat CAH?

A

Gluco and mineral

17
Q

What are three categories of non endocrine conditions we give glucos for?

A

Immunosuppression, inflammatory conditions, allergic conditions.

18
Q

What 3 clinical applications for prednisolone?

A

Inflammatory conditions, organ transplantation, and hematologic cancers

19
Q

What are 5 general principles to follow when administering steroid?

A

Lowest dose for shortest duration possible
Don’t give systemically if you can do it some other way
Give single doses in the AM
Pulse therapy
Taper off to allow the HPA to recover

20
Q

What medicine to give for secondary or tertiary adrenocortical insufficiency?

A

Hydrocortisone

21
Q

What are three “other” effects of cortisol to know?

A

Suppresses TSH
Maintain GFR
Vascular tone

22
Q

What two drugs can be given to pregnant mothers a couple days before delivery and why?

A

Betamethasone and dexamethasone

Babies might have premature lung development or RDS and these two drugs can accelerate lung maturation.

23
Q

What is the steroid of choice for pregnancy and why?

A

Prednisone because it does not have steroid effects on the fetus

24
Q

What is the most common adverse effect of steroid use?

A

Osteoperosis

25
Q

What are three other common adverse effects of glucos?

A

Cushing syndrome, hyperglycemia and cataracts

26
Q

What 8 patient populations are glucos problematic?

A

Immunocompromised, diabetes, infections, peptic ulcers, cardiac issues, psychiatric problems, Osteoporosis and children

27
Q

What is mifepristone and what is its clinical applications? 2.

A

Gluco antagonist.

Medical abortions and rarely for cushings

28
Q

Main job/effect of minerals?

A

Retain sodium and water and get rid of potassium and protons

29
Q

What is the clinical application of fludrocortisone?

A

Adrenal insufficiency, addisons. Strong mineral agonist and some gluco.

30
Q

MOA of spironolactone and what are the 3 clinical applications?

A

Blocks mineral receptor

Hyperaldosteronism, hypokalemia, and heart failure.

31
Q

What is the MOA of ketaconazole and what is the 1 clinical app?

A

Inhibits gonadal and adrenal steroid hormone synthesis by blocking cyp 450s.
Cushings

32
Q

What is the mechanism of action for eplerenone and what is its clinical use?

A

Aldosterone antagonist which helps with the male boob effect with spironolactone.
Hypertension and heart failure.

Endo Final Pharm (7 decks)

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