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[ENDO] REPRO II FINAL EXAM > [PHARM] Adrenal Corticosteroids > Flashcards

[PHARM] Adrenal Corticosteroids Flashcards

1
Q

Pharmacologic doses of corticosteroids are use to treat what type of patients?

A

Inflammatory

Allergic

Immunologic

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2
Q

Corticosteroids are use for what 3 specific diseases?

A

Cushings Syndrome

Adrenal Insuf

CAH

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3
Q

What are the 2 groups of Corticosteroid Agonists?

A

Glucocorticoids – (Prednisone)

Mineralcorticoids – (Fludrocortisone)

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4
Q

What are the 2 groups of Corticosteroid Antagonists?

A

Receptor Antagonists (Glucorticoid and Mineralcorticoid)

Synthesis Inhibitors (Ketoconazole)

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5
Q

Aldosterone and Cortisol bind to what and why does this matter?

A

Both bind to Mineralcorticoid Receptor EQUALLY, so you need to think about this when you prescribe it.

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6
Q

What does 11 Beta Dehydrogenase do?

What does 11 Beta-Ketoreductase do?

A

Converts Active Steroids into Inactive Steroids

Converts Inactive Steroids into Active Steroids

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7
Q

What are the Short Acting Glucocorticoids?

(8-12 hrs)

A

Hydrocortisone

Cortisone

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8
Q

What are the Intermediate Glucocorticoids?

(12-36 hrs)

A

Triamcinalone

Prednisone

Prednisolone

Methlyprednisolone

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9
Q

What are the Long Acting Glucocorticoids?

(36+ hrs)

A

Betamethasone

Dexamethasone

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10
Q

What is the name of the Amylin Analog drug that is used for Anti-Diabetic w/ insulin?

A

Pramlintide

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11
Q

What is the drug that is used in the treatment of cancer of the adrenal glands?

A

Mitotane

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12
Q

What drug is used for dx of adrenal insuff, and tx of cushing syndrome?

A

Metyrapone

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13
Q

What drug is used for medical abortions, and can cause vaginal bleeding?

A

Mifeprostone

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14
Q

What are the 2 main therapeutic effects of steroids?

What are the 2 secondary effects?

A

Immunosuppression and Anti-Inflamm

Anti-Allergy and Sec Pain Relief

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15
Q

What are some of the side effects with taking steroids?

A

Infections

Myopathies

Osteoporosis

Skin Thinning

Hyperglycemia

HPA Insuff

Cataracts/Glaucoma

HTN

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16
Q

What are some of the factors that influence both therapeutic and adverse effects?

A

Biologic Potency

Pharmacokinetic prop

Daily Dose

Timing of Dose

Ind Differences in metabolism

Duration of Tx

17
Q

What is the criteria for therapy of steroids in Medical Emergencies?

A

High Dose for a few days – with little risk

(Never have it replace more specific primary therapies)

18
Q

When considering chronic steroid therapy what must you always remember?

A

You cant give it, without ADVERSE EFFECTS happening

remember the Dose/Frequency/RoA/Disease indexes

19
Q

What are some of the guidelines for corticosteroid therapy?

A

Intiate only is published evidence and therapeutic benefit

Use only after other specific therapies fail

Identify a specific therapeutic objective

Sufficient Time to get a good response

Dont give longer than necessary

Terminate if benefit not observed, complications, maximum benefit reached

20
Q

What is typical combo of steroids used for Addisons Dz?

A

Hydrocortisone and Fludrocortisone

21
Q

What is the typical combo for CAH?

A

Hydrocortisone and Fludrocortisone

22
Q

If a patient has an Autoimmune Dz, Hematologic Cancers, Rheumatoid Arth, IBD, Asthma/COPD, or Allergic Rhinitis – what should you consider in their therapy?

A

Corticosteroids

23
Q

How do Glucocorticoids affect the Immune System and thus Inflammation?

A

Decrease Prostaglandins/Leukotrienes

Increased Apoptosis of Immune Cell Types

Decreased Cytokines

Decreased Migration of Neutrophils/Mo

(Causes IMMUNE SUPPRESSION!!)

24
Q

Glucocorticoids affect Carbohydrate Metabolism how?

A

Increased Gluconeogenesis, Glucose Output, Glycogen Synthesis

Decreased Glucose Uptake

25
Q

Glucocorticoids affect Lipid Metabolism how?

A

Increased Lipolysis, FFA and Glyercol, Lipogenesis, Fat Depositions, Fat Distribution

26
Q

Glucocorticoids affect Protein Metabolism how?

A

Decreased AA uptake, protein synthesis (Muscle wasting)

27
Q

Glucocorticoids have an Anti-Insulin effect and this can cause what?

A

Hyperglycemia

28
Q

What are some known Inhibitors of 11 Beta- Dehydrogenase?

A

Glycyrrhizin (Licorice root)

Carbenoxolone

(eating Licorice causes INCREASED BP, in these pts)

29
Q

What types of pts should you worry about giving corticosteroids too?

A

HIV/AIDS

Diabetics

Pts w/ Infxns

HTN/CHF/Angina Pts

Psychiatric Conditions

Osteoporosis

CHILDREN!

30
Q

When dosing a Corticosteroid what rules should you follow?

A

Lowest dose for the shortest duration

Reduce distribution of drugs into systemic circulation

Give 1x in AM

(Alternate Days)

Dose Tapering (allow HPA recovery)

31
Q

In terms of the equivalent dose, how does Dexamethasone compare to Hydrocortisone?

A

a Dose of Dexamethasone is 0.75mg = 20mg equivalent dose of Hydrocortisone

32
Q

In general what are some trends you can make regarding dosages, anti-inflamm activity etc.

A

Short Acting –> Have higher needed doses (20 mg) and have less anti-inflammatory activity than . . .

Long Acting –> which need lower doses (0.75mg) and have higher anti-inflammatory properties

33
Q

What is primary mineralocorticoid?

What does it do?

A

Aldosterone

Influences Salt and Water Balance

(Sodium and Water retention and active excretion of K and H)

34
Q

What is the one Mineralcorticoid AGONIST?

Long or Short Acting?

A

Fludricortisone

(is an agonist for M and G receptors)

LONG ACTING

35
Q

What are the two Mineralcorticoid ANTAGONISTS (K+ Sparing Diuretics)?

A

Spironolactone

Eplerenone

36
Q

Eplerenone is cleared by what?

A

CYP 450/34A

(half life of 3 to 6 horus)

37
Q

Spironolocatone causes what?

Eplerenone causes what?

A

Hyperkalemia

Gynecomastia in males

Hyperkalemia

Increased Creatinine

38
Q

What is the 1 synthesis inhibitor?

What does it do?

A

Ketoconazole

Blocks Fungal Ergosterol; and CYP450 Enzymes

(Lots of drug-drug interactions)

[ENDO] REPRO II FINAL EXAM (13 decks)

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