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Therapeutics > Lecture 16: Corticosteroids > Flashcards

Lecture 16: Corticosteroids Flashcards

1
Q

Adrenal Gland secretion

A

-corticoids
-androgens
-epi and NE

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2
Q

Adrenocorticoids

A

-glucocorticoids
-mineralocorticoids

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3
Q

Glucocorticoids

A

-stress hormones
-inc circulating glucose
-potent anti-inflammatory efects

-cortisol

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4
Q

Mineralcorticoids

A

-Na+ retention
-inc BV
-inc BP

-aldosterone

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5
Q

Epinephrine mode of action

A

-binds B-receptor (GPCR)
-initiate signal transduction cascade
-induce immediate response
-break down glycogen
-release glucose

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6
Q

Cortisol (hydrocortisone) mode of action

A

-binds to glucocorticoid receptor (nuclear)
-regulate gene transcription/translation/protein production
-induces long term response
-induces gluconeogenic enzymes
-inhibit inflammatory processes

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7
Q

CRH

A

-corticotropin releasing hormone
-induced by stress
-inhibited by cortisol feedback

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8
Q

ACTH

A

-adrenocorticotropic hormone
-induced by stress and CRH
-inhibited by cortisol feedback

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9
Q

Mineralcorticoid synthesis

A

-not by the anterior pituitary!
-renin-angiotensin-aldosterone system

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10
Q

renin-angiotensin-aldosterone system

A

-liver to angiotensinogen to angiotensin I (renin)
-I to II (ACE)
-II to aldosterone in adrenal glands

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11
Q

Glucocorticoid Responsive Elements (GRE)

A

-specific DNA seq where DNA-binding domain of activated dimers
-alter rate of transcription

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12
Q

Enzymes upregulated by glucocorticoids

A

-PEP carboxykinase
-lipocotrin I
-enzymes for gluconeogenesis and anti-inflammatory proteins

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13
Q

PEP carboxykinase

A

-catalyzes rate-limiting step in gluconeogenesis
-upregulated by glucocorticoids

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14
Q

Lipocortin I

A

-suppress phospholipase A2 which has a critical role in eicosanoid synthesis
-upregulated by glucocorticoids

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15
Q

Mech of immunosuppression by glucocorticoids

A

-activated glucocorticoid receptor (GR) binds NFkB
-prevents NFkB binding to its response element
-repress cytokine genes

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16
Q

Physiological effects of glucocorticoids

A

-inc blood glucose levels
-immunosuppression

17
Q

Physiological effect of glucocorticoid on liver

A

-inc gluconeogenesis
-inc glycogen storage

18
Q

physiological effect of glucocorticoid on muscle

A

-promote protein degradation
-dec protein synthesis
-dec sensitivity to insulin

19
Q

physiological effect of glucocorticoids on adipose tissue

A

-promote lipolysis
-dec sensitivity to insulin

20
Q

Physiologic effect of glucocorticoids on the immune system

A

-block cytokine synthesis (immunosuppression)
-block eicosanoid synthesis (anti-inflammation)

21
Q

Adrenal insufficiency

A

-HYPOadrenalism
-decreased secretion of steroid hormones by adrenal cortex

22
Q

Adrenal insufficiency causes

A

-primary: destruction of cortex by TB or atrophy (addison’s disease)
-secondary: dec secretion of ACTH due to disease of anterior pituitary

23
Q

Adrenal insufficiency symptoms

A

-weakness
-anorexia/anemia/nausea
-depression

24
Q

Primary adrenal insufficiency

A

-destruction of cortex by TB or atrophy
-addison’s disease
-Low BP and hyperpigmentation of skin as additional symptoms

25
Q

Cessation of long-term systemic glucocorticoid therapy can lead to

A

Addisonian symptoms

26
Q

Primary adrenal insufficiency effect (adrenal defect)

A

-inc CRH
-inc ACTH
-dec Cortisol
-dec Aldosterone

27
Q

Secondary adrenal insufficiency effect (pituitary defect)

A

-inc CRH
-dec ACTH
-dec Cortisol
-aldosterone unaffected

28
Q

Tertiary adrenal insufficiency effect (hypothalmic defect)

A

-dec CRH, ACTH, Cortisol
-no effect on aldosterone

29
Q

Cushing’s disease

A

-HYPERadrenalism
-adrenal, pituitary, or ectopic

30
Q

Causes of Cushing’s disease

A

-tumors in adrenal cortex
-inc ACTH production due to pituitary carcinoma
-ectopic production of ACTH bc non-pituitary carcinoma

31
Q

Symptoms of Cushing’s disease

A

-inc protein catabolism (bruising/wasting)
-inc glucose levels
-osteoporosis
-opportunistic infections

32
Q

Long-term therapeutic use of systemic glucocorticoids can lead to

A

Cushing’s symptoms

33
Q

Adrenal Cushing’s effect

A

-dec CRH
-dec ACTH
-inc Cortisol

34
Q

Pituitary Cushing’s effect

A

-dec CRH
-inc ACTH
-inc Cortisol

35
Q

Ectopic Cushing’s effect

A

-dec CRH
-dec ACTH
-inc ectopic ACTH
-inc Cortisol

Therapeutics (78 decks)

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