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Pharmacology > Steroid Drugs > Flashcards

Steroid Drugs Flashcards

1
Q

What are the layers of adrenal gland and their hormones

A

Cortex:
Zona glomerulosa - mineralocortocoid
Zona fasciculata - glucocorticoid
Zona reticularis - sex steroid

Medulla - catecholamines

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2
Q

What are corticosteroids

A

Hormones synthesised in adrenal cortex, synthesised from cholesterol

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3
Q

What is control mechanism of glucocorticoid synthesis

A

HPA axis and negative feedback:
Hypothalamus - CRH
Anterior pituitary - ACTH
Adrenal cortex - Cortisol

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4
Q

What is the action of cortisol

A 
Gluconeogenesis and glycogenolysis
Hyperglycaemia 
Proteolysis
Lipolysis
Lipid deposition (high conc)
Lipid redistribution (abdomen, neck)
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5
Q

What are the effects of cortisol deficiency

A

Hypoglycaemia
Weight loss, reduced appetite
Hypotension

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6
Q

What are effects of cortisol excess

A

Hyperglycaemia
Weight gain, increased appetite
Cushing’s syndrome
Hypertension

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7
Q

What are effects of aldosterone deficiency

A

Hypotension
Hyponatraemia
Hyperkalaemia
Dehydration

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8
Q

What are effects of aldosterone excess

A

Hypertension
Hypernatraemia
Hypokalaemia

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9
Q

What does cross over mean

A

GC can have MC like activity by binding to MC receptors

Due to similar structures of MC and GC receptors

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10
Q

What determines level of cross over activity

A

Level of selectivity of hormone for GC and MC receptors

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11
Q

What are the different selectivities of different corticosteroids

A 
Fludrocortisone: High MC, Low GC
Hydrocortisone: MC = GC 
Prednisolone: Low MC, High GC
Betamethasone: minimal MC, v High GC
Dexamethasone: minimal MC, v High GC
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12
Q

What are the potencies of different corticosteroids

A

Hydrocortisone: 20mg
Prednisolone: 5mg
Dexamethasone: 750 mcg
Betamethasone: 750mcg

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13
Q

What are the routes of admin of corticosteroids

A

Systemic:
Oral
IV

Local:
Inhaled
Intra articular
Topical

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14
Q

What is cellular mechanism of action of steroids

A 
Inhibit B + T cell responses
Inhibit NF-kB (inflammatory signalling molecule)
Reduced phagocyte function 
Reduced inflammatory cytokine synthesis
Reduced cell adhesion molecule synthesis
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15
Q

What is molecular mechanism of action of steroids

A

Corticosteroids are lipophillic, freely cross cell membrane
Bind to intracellular GC receptors
HSP bound to receptor dissociates on hormone binding
Hormone-receptor complex binds to hormone responsive element on DNA
Control gene transcription
Transactiation: upregulation of gene expression of genes in anti-inflammatory pathway - e.g. Annexin
Transrepression: down regulation of gene expression of genes in inflammatory pathway - e.g. NF-kB
Cisrepression: genes outside inflammatory pathway affected - POMC, Osteocalcin, Keratin

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16
Q

What are clinical indications of corticosteroids

A 
Inflammatory disease
Malignancy
Immunosuppression
Diagnosis of Cushing’s disease - dexamethasone suppression test 
Adrenal insufficiency
Preterm birth
17
Q

What corticosteroids are used for replacement therapy in adrenal insufficiency

A

Fludrocortisone - replace MC

Hydrocortisone - replace GC

18
Q

Why do you give steroids in preterm birth

A

Given to women at risk of pre term birth
Single dose in antenatal period
To reduce risk of respiratory distress syndrome
Steroids stimulate T2 pneumocytes

19
Q

What corticosteroids are used in preterm birth

A

Betamethasone

Dexamethasone

20
Q

What are MC side effects of corticosteroids

A

Hypertension
Hypokalaemia
Fluid retention

21
Q

What are GC side effects of corticosteroids

A

Endocrine: hyperglycaemia, hyperlipidaemia, weight gain/appetite, hirsuitism
Cushing’s syndrome: moon face, buffalo hump, striae
MSK: proximal myopathy, AVN of femoral head, osteoporosis
Immunosuppression: risk of severe infection, TB reactivation
GI: peptic ulcer, acute pancreatitis
Psych: insomnia, depression, mania, psychosis
Eye: cataracts, glaucoma, papilloedema
Intracranial hypertension
Growth disturbance in children
Fever, raised WCC

22
Q

Why do you get osteoporosis with corticosteroids

A

Inhibit osteocalcin synthesis - reduced osteoblast formation
Increased osteoclasts proliferation
Reduced Ca absorption from gut
Reduced sex steroid synthesis

23
Q

Why do you get adrenal suppression with corticosteroids

A

LT CS therapy mimics high dose of cortisol for long period
Suppress HPA axis by negative feedback
Suppress cortisol synthesis

24
Q

When do you get adrenal suppression

A

Prolonged/High dose CS therapy:
>3 weeks
>40mg of prednisolone daily for 1week

25
Q

How do you manage patients on long term corticosteroids

A

Carry steroid card
Increase dose during intercurrent illness/before surgery
Gradual withdrawal if: >3wks or >40mg pred for a week

26
Q

What occurs in hypoadrenal crisis

A 
Hypoglycaemia 
Hyponatraemia 
Hypotension
Hyperkalaemia 
Severe dehydration
Death

Pharmacology (19 decks)

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