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Pharm Test 3 > Steroid > Flashcards

Steroid Flashcards

1
Q

Rx list

A 
Aldosterone
Hydrocortisone (cortisol)
Prednisolone
Dexamethasone
Fludrocortisone
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2
Q

Adrenal steriods

  • blood
  • types
A
  • own blood supply , from adrenal gland
  • Glucocorticoids = anti-inflammatory, carb/protein metab
  • Mineralocorticoids = water, elecrolyte balance
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3
Q

Steroid hormones synthesis

A

From cholesterol

Enzyme deficiency = everything downstream blocked

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4
Q

Which has high salt-retention?

A

Fludrocortisone

Mineralocorticoid replacement steroid of choice

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5
Q

Cortisol

Stimulated by

A

ACTH

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6
Q

Aldosterone

Stimulated by

A

Angiotensin 2 and K+

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7
Q

Hypothalamic-Pituitary-Adrenal (HPA) axis

How release cortisol

A
  • Hypothal releases CRH
  • Anterior pituitary releases ACTH
  • stim cortisol
  • cortisol - negative feedback regulation to posterior pituitary + hypothalamus

*Immune modulators can stim Hypothalamus/Ant. Pituitary

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8
Q

Glucocorticoid synth peaks in

A

Morning

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9
Q

Glucocorticoid during day

A

Peaks and troughs

Aldosterone less amount than ACTH

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10
Q

What does not effect ACTH secretion?

A

Aldosterone

Prob due to low level

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11
Q

Action of glucocorticoid in cell

A

Regulatory factors change (coactivator/corepressor)

Transrepression= alter other non steroid transcription factors

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12
Q

Glucocorticoid effects

A
  • Blood glucose (UP liver synth, protein breakdown (muscle), free fatty acids (lipolytic signals NOT In face, back of neck)
  • Calcium (down renal reabsorb, SLOW BONE GROWTH, Ca/Mg/PO4
  • Cardio (HTN)
  • Skeletal muscle wasting
  • CNS - mood
  • endocrine = DOWN growth hormone secretion, UP epinephrine, DOWN major hormone-binding proteins
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13
Q

Anti-inflammatory/immunosupressive

A

*STOP monocyte proliferation/antigen presentation
DOWN cytokine synthesis

  • DOWN lymphocyte cytokine production
  • DOWN prostaglandin/leukotriene products

DON’T FIX UNDERLYING DISEASE

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14
Q

GRE

A

Nucleotide sequence recognized by steroid receptor complex

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15
Q

How to inhibit inflammatory effects via Glucocorticoid receptor

A
  • UP annexin A1 (lipocortin 1) = inhibit Phospholipase A2
  • DOWN COX 2 synth (down macrophage, synoviocyte)
  • DOWN TNF-a synth
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16
Q

TNF-a effect

A

Signal for many cell types in inflamation :

Macrophages, neutro, etc.

17
Q

Corticosteroid Target Tissue Specificity

A

Cortisol binds to Mineralocorticoid receptor

Mineralocorticoid target tissue inactivates cortisol to cortisone with 11b-HSD2 = stop excessive stimulation to regulate aldosterone-receptor overactivity

18
Q

What can do same stuff as aldosterone on mineralocorticoid receptor?

19
Q

Licorice inactivates

A

Glycirrhizic acid inactivates enzyme (11B-HSD2)

Can’t convert cortisol to cortisone = too much cortisol, so high BP from adosterone receptor

20
Q

Corticosteroids

Absorption
Metab
T1/2

A

Well absorbed

Liver metab to urine

Cortisol-VARY BY PATIENT (60-90mins)

21
Q

Adrenocorticoid use

A
  • Fetal lung maturity
  • Hypercorticism
  • Replacement Therapy (fludrocortisone)
22
Q

Pituitary tumor

(Ectopic)

A

Dexamethasone suppression test

*will supress ACTH from pituitary but NOT from ectopic tumor)

23
Q

Glucocorticoid toxicity

A

Not less than 2 weeks

can give cushing’s syndrome

24
Q

Glucocorticoid

S.E.

A
  • HTN
  • Hyperglycemia
  • Up Infxn
  • Osteoporosis/necrosis
25
Q

giving synthetic cortisol will inhibit

26
Q

Glucocorticoid effects

A

*Anti-inflammatory

27
Q

Mineralocorticoids

A
  • Water

* Electrolyte balance

28
Q

MIneralocorticoid replacement therapy?’

Rx

A

Fludrocortisone

29
Q

How does ACTH act on cortisol secreting cells in adrenal cortex?

A

ACTH binds —>up cAMP —> up Cholesteryl Ester Hydrolase (CEH) activity —> make Free Cholesterol —> products shuttled b/w mitochondria + smooth ER

30
Q

Effects on carb/protein/lipid metab

A
  • **UP glucose synth by liver
  • **UP glucose storage in glycogen
  • protein breakdown (skeletal muscle)
  • UP free fatty acids (fat redistribution)
31
Q

Effects on Ca2+ homeostasis

A
  • DOWN renal reabsorption

* DOWN Ca2+/Mg/PO4 absorption GI

32
Q

Cardio effects

33
Q

Endocrine effects

A
  • DOWN growth hormone

* UP epinephrine synthesis

34
Q

Overall effects

A
  • Carb/Protein/Lipid
  • Ca2+ homeostasis
  • Cardio
  • CNS
  • Skeletal Muscle
  • Endocrine
35
Q

Neuroendocrine control of glucocorticoids

3 mechs

A
  • episodic secretion (circadian rhythm)
  • Stress responsiveness (HPA axis)
  • feedback inhibition by cortisol on ACTH secretion
36
Q

Aldosterone

How regulate extracellular volume?

A

Bind to Renal Cortical collecting duct Mineralocorticoid Receptor (MR –> activated MR to nucleus (transcription factor)–>ENaC (K in Na out) –>H20 out (extracellular) HTN up

11B-HSD2 receptor BLOCKS glucocorticoids from MR

Pharm Test 3 (11 decks)

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