Mod 1 lecture 1: corticosteroids and antagonists

Question 1

what are the naturally occuring glucocorticoids

Answer 1

cortisol (hydrocortisone)
cortisone

Question 2

what is the primary action of cortisol and cortisone

Answer 2

‘stress hormone’

Question 3

what does cortisol and cortisone cause in the body

Answer 3

gluconeogensis in the liver - increase serum glucose
protein catabolims in extrahepatic tissue
fat catabolims in extrahepatic tissue
inhibits glucose uptake in muscle and adipose

Energy

Question 4

what are the inflammatory and immune function of cortisol and cortisone

Answer 4

anti-inflammatory effects
immune response suppression
increase catecholamine production and response - increase BP

Question 5

what releases CRH

Answer 5

hypothalamus

Question 6

what releases ACTH

Answer 6

anterior pituitary

Question 7

what releases cortisol

Answer 7

adrenal cortex

Question 8

what does cortisol inhibit

Answer 8

CRH and ACTH

Question 9

where is cortisol metabolized

Answer 9

liver

Question 10

what are the corticosteroids

Answer 10

betamethasone
cortisone
dexamethasone
hydrocortisone
prednisone
methyprednisolone
triamcinalone

Question 11

what are the mineralocorticoid agnoists and antagonists

Answer 11

fludrocortisone
spironolactone
eplerenone

Question 12

what are the PK of corticosteroids

Answer 12

bound to corticosteroid bidning protein or albumin. metabolized by the liver and excreted by the kidney.
in CKD - would expect lower plasma protein, increased clearance, decreased t1/2. exception: prednisolone

Question 13

What are the short acting glucocorticoids

Answer 13

1-12 hours
hydrocortisone and cortisone
have mineralocorticoid activity
liver will convert cortisone to hydrocortisone
kidney will convert hydrocortisone to cortisone

Question 14

what are the intermediate acting glucocorticoids

Answer 14

12-36 hours
prednisone
prednisiolone
methyprednisiolne
triamcinolone

Question 15

what are the long acting glucocorticoids

Answer 15

36-55 hours
betamethasone
dexamethasone

Question 16

what are the key points regarding intermediate acting glucocortioids

Answer 16

have significanly more affinity to glucocortioid receptors
triamicolone has NO mineralocorticoid effects
prednisone is a prodrug that is first convered by the liver to prednisolone which is then metabolized

Question 17

what are the key points regarding long acting glucocorticoids

Answer 17

only bind to glucocorticoid receptor
used for high dose injections and lung maturation
potency is important to keep in mind

Question 18

what are the adrenal use for glucocorticoids

Answer 18

replacement therapy (hydrocortisone)
diagnosis of cushings syndrome (dexamethasone)

Question 19

what are the non-adrenal uses of glucocorticoids

Answer 19

anti - inflammatory
anti-allergy
acceleration of lung maturation (antenatal)

Question 20

what are the oral glucocoritoids

Answer 20

cortisone
dexamethasone
methyprednisolone
prednisone

Question 21

what are the intra-articular glucocorticoids

Answer 21

methyprednisolone
tramcinolone

Question 22

what are the inhaled/nasal glucocorticoids

Answer 22

beclomethasone
budesonide
flunisolids
fluticasone
mometasone
triamcinolone

Question 23

what are the IV/IM drugs

Answer 23

betamethasone
dexamethasone
hydrocortisone
methyprednisonlone
prednsolone

Question 24

what is an IM glucocortioid

Answer 24

triamcinolone

Question 25

what is low dose dexamethasone test

Answer 25

diagnosis of cushings syndrome dose given is sufficient of insufficient to suppres the cortisol production - not in Cushings

Question 26

what is seen with pituitary adenoma

Answer 26

high dose Dex low ACTH Low Cotisol

Question 27

what is seen with adrenal tumor

Answer 27

high dose Dex Low ACTH High Cortisol

Question 28

what is seen with Pananeoplastic (ACTH tumor)

Answer 28

High dose Dex High ACTH High Cortisol

Question 29

what is seen with Cushings syndrome

Answer 29

low dose Dex normal or high cortisol

Question 30

what is seen with normal HPA-Anxis

Answer 30

low dose Dex low ACTH low/normal Cortisol

Question 31

What are the AE of glucocorticoids

Answer 31

Derm: skin thinning, weight gain, acne, cushingoid appearance, hirsutism, facial erythema, striae Eyes: cataract, intraoc pressure/glaucoma, exophthalmos Heart: fluid rentention, HTN, arrhythmias GI: gastritis, peptic ulcer, visceral perforation MSK: osteopososis, AVN, myopathy CNS: euphornia, depression, insomnia, akathisia, mania metabolism: hyperglycemia immune: increased infection risk heme: leukocytosis

Question 32

what pre-existing conditions have increased risk of complication with glucocortioids

Answer 32

DM HTN HF and peripheral edema cataracts glaucoma PUD infection Low bone density/osteoporosis

Question 33

what is the naturally occuring mineralocorticoids

Answer 33

aldosterone

Question 34

what is the action of aldosterone

Answer 34

regulate salt and water metabolism - increase salt reabsorption -increase potassium excretion - increase hydrogen ion excretion

Question 35

what is Fludrocortisone

Answer 35

synthetic mineralocorticoid -mineralocoriticoid activity - salt and water retainin properties - some glucocorticoid activity

Question 36

what are the indication for Fludrocortisone

Answer 36

Addison's disease treatment and associated mineralocoritocid deficiency