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Pharma S1Y2 > Steroid hormones > Flashcards

Steroid hormones Flashcards

1
Q

what is the function of aminoglutethimide ?

A

it inhibit the conversion of cholesterol to pregnenolone via p450scc enzyme

This will inhibit the whole adrenal hormones cascades cuz pregnenolone is the precursor of all adrenal hormones

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2
Q

what is the function of ketoconazole/ metyrapone ?

A

inhibit the 11 b hydroxylase which will inhibit the formation of aldosterone/ cortisol

11 B hydroxylase is the enzyme responsible for forming aldosterone and cortisol

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3
Q

what is fludrocortisone ?

A

a synthetic mineralocorticoids

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4
Q

when is fludrocortisone used?

A

it is a synthetic mineralocorticoids so it is used in aldosterone deficiency

like patients with primary adrenal insufficiency —-> Addison disease

Flud —> fluid —> aldosterone —> increase fluid and sodium retention

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5
Q

what are the common uses of glucocorticoids a?

A

anti inflammatory , allergic , autoimmune , other disorders

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6
Q

what are the administration methods of glucocorticoids and what is the best one? ?

A

oral, parental, inhalation , topical

topical / inhalation are the best

cuz well tolerated and avoid most systemic adverse effects of glucocorticoids

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7
Q

what are the short acting low potency glucocorticoids ?

A

cortisol

cortisone

fludrocortisone

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8
Q

what is the other name of cortisol?

A

hydrocortisone is the pharmaceutical name for cortisol

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9
Q

what is the special feature of cortisone ?

A

cortisone is a prodrug , requires activation by the LIVER

once its metabolized it will become hydrocortisone

Cortisone is js more stable as a prodrug than cortisol ( hydrocortisone )

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10
Q

which one you should administer in liver failure?

A

cortisol ( hydrocortisone ) because it doesnt require activation unlike cortisone which requires metabolization

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11
Q

what are the uses of cortisol and cortisone?

A

hormone replacement therapy in adrenal insufficiency patients

anti inflammatory agents BUT the more potent ones are used for most inflammatory , allergic , autoimmune disorders

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12
Q

what are the medium potency , intermediate acting glucocorticoids?

A

prednisone

prednisolone

methylprednisolone

Triamcinolone

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13
Q

what are the uses of medium potency intermediate acting glucocorticoids ?

A

systemic treatments

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14
Q

what is the special feature about prednisone?

A

in the body it gets converted to prednisolone

so in cases of liver failure you cant give prednisone

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15
Q

what are the uses of intermediate acting glucocorticoids?

A

cancer

inflammation

allergy

autoimmune disorders

action last for 12 to 36

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16
Q

what are the high potency long acting glucocorticoids ?

A

betamethasone

dexamethasone

budesonide

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17
Q

what are the uses of betamethasone?

A

systemic use

topical treatment of skin disorders —> psoriasis , atopic dermatitis and neurodermatitis

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18
Q

what are the uses of dexamethasone?

A

diagnostic dexamethasone suppression test

treatment of neoplastic , infections , inflammatory conditions

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19
Q

how is budesonide administered ?

A

inhalation

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20
Q

what are the indications for steroids?

A

inflammation, allergy, autoimmune disorders —> suppress inflammation and immune dysfunction associated with disease affecting most every organ in the body

Cancer

Respiratory distress

adrenal insufficiency

congenital adrenal hyperplasia

cushing syndrome

dermatological diseases

other disorders

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21
Q

which steroid drug is used in LUPUS?

A

prednisone —-> intermediate

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22
Q

which steroid drug is used in multiple sclerosis?

A

prednisone

metyhlprednisolone –> intermediate

dexamethasone ———-> long acting

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23
Q

which drug is used in ulcerative colitis ?

A

methylprednisolone –> intermediate

budesonide –> inhaled long acting

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24
Q

what are the drugs indicated for allergic rhinitis

A

beclomethasone ——-> long acting

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25
Q

what is the newest agent for allergic rhinitis ?

A

ciclesonide

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26
Q

what are the agents for asthma ?

A

triamiclnolone
budesonide
ciclesonide
flunisolide
mometasone
flucticasone

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27
Q

why are glucocorticoids used in cancer?

A

lymphotoxic effects

used in lymphocytic leukemia and lymphomas

28
Q

why is dexamethasone used in combination with other drugs for cancer?

A

it prevents emesis during cancer chemotherapy

29
Q

what is the drug used in respiratory distress syndrome ?

A

betamethasone —> long acting

30
Q

why is betamethasone the drug choice for respiratory distress syndrome?

A

it is used in premature infants

and it acts by promoting fetal lung maturation in the same manner as endogenous cortisol

31
Q

what hormones are deficient in primary adrenal insufficiency ?

A

cortisol

aldosterone

androgens

32
Q

what hormones you have to give in primary adrenal insufficiencies ?

A

Fludrocortisone —-> for aldosterone

hydrocortisone –> for cortisol

33
Q

what hormones are deficient in secondary adrenal insufficiency ?

A

cortisol and androgens

ALDOSTERONE IS NORMAL

secondary adrenal insufficiency is usually due to prolonged administration of corticoids and ACTH deficiency

34
Q

what hormones you have to give secondary adrenal insufficiency ?

A

you only give cortisol —> hydrocortisone /glucocorticoids

no need for fludrocortisone cuz no aldosterone deficiency

35
Q

what is acute adrenal insufficiency?

A

aka adrenal crisis, addisonian crisis

medical emergency that happens when someone is under stress but there are not corticoids to help him

36
Q

how do you treat acute adrenal insufficiency ?

A

IV hydrocortisone 48 hours

followed by long term oral hydrocortisone

37
Q

how is chronic adrenal insufficiency treated?

A

HYDROCORTISONE orally in a manner that mimics the circadian secretion of cortisol —–> 2/3 of the dose at morning and 1/3 of it at the nigt

38
Q

what is congenital adrenal hyperplasia? CAH

A

group of disorders caused by specific enzyme deficiencies that impair the synthesis of cortisol and aldosterone

this usually results in a shift towards androgens

39
Q

why do we have adrenal hyperplasia in cases of CAH?

A

cuz impaired synthesize of cortisol and aldosterone will result in increased ACTH —>Hyperplasia

40
Q

what are the characteristics of CAH?

A

since theres a shift towards production of adrenal androgens —> virilization —–> masculinization —-> in girls
pseudo hermaphroditism —-> in girls

41
Q

what is the commonest enzyme defect in CAH?

A

21 hydroxylase –> 90% of the cases

11b hydroxylase —-> 9% of the cases

42
Q

how is CAH treated?

A

hydrocortisone to stop ACTH secretion

fludrocortisone to treat aldosterone deficiency

43
Q

how do you treat cushing syndrome due to excessive levels of ACTH?

A

surgery

irradiation

adrenal steroid inhibitors

cuz its usually due to pituitary adenoma that release excessive ACTH –> adrenal hyperplasia

other causes : adrenal adenomas, adrenal carcinomas, ectopic corticotropin ACTH secreting tumors

44
Q

how is cushing syndrome diagnosed ?

A

free cortisol levels in the urine

dexamethasone suppression test

person with cushing syndrome dexamethasone will not suppress corticotropin ( ACTH ) secretion

45
Q

what are the dermatologic conditions where you use corticosteroids ?

A

Atopic ( contact )

sberrheic dermatitis

pruritus –> itching

psoriasis

sunburn

46
Q

on which part of the skin you use low potency drugs?

A

areas of thin skin —-> face and eyes

intertriginous areas where skin is folded or overlapped

47
Q

which part of the skin you use medium potency drugs?

A

ear

trunk

Arm

legs

scalp

48
Q

which part of the skin you use high potency drugs?

A

palms and soles

49
Q

what are the low potency TOPICAL STEROIDS?

A

hydrocortisone –> cortisol

desonide

hydrate under de Sun

50
Q

what are the medium potency topical steroids ?

A

Triamcinolone

fluticasone

Try the flute

51
Q

what are the high potency steroids?

A

desoximetasone

fluocinonide

Remove your socks ( de sox ) when you have flu

52
Q

what are the very high potency steroids ?

A

betamethasone

dexamethasone

clobetasol

A BCD ( Beta clobe dexa )

53
Q

what are the other uses of glucocorticoids ?

A

hypercalcemia

sarcoidosis

immunosuppressants to prevent organ rejection

54
Q

what are the side effects of long term uses of glucocorticoids ?

A

Symptoms of cushing syndrome

moon face
Brusing
peptic ulcer
hypertension
centripetal obesity
Striae
menstral disturbance
Etc

55
Q

what is the major Adrenal androgen and whats its major use?

A

Dehydroepiandrosterone DHEA
major androgen secreted by the cortex

extremely weak androgen —> converted to testosterone

NO CLINICAL USE

56
Q

what is aminoglutethimide ?

A

corticosteroid synthesis inhibitor that inhibit P450SCC

stops conversion of cholesterol to pregnenolone

57
Q

what are the uses of aminoglutethimide?

A

it inhibits all steroids

Breast cancer

malignant adrenocortical tumors

Cushing syndrome along with metyrapone

58
Q

what is metyrapone ?

A

corticosteroid synthesis inhibitor that inhibit 11B hydroxylase enzyme

it inhibits aldosterone / cortisol pathway and shifts it all to androgen pathway

59
Q

what are the uses of metyrapone ?

A

cushing syndrome along with aminoglutethimide

me tired ill sleep on the cushion

60
Q

what are ketoconazole and fluconazole ?

A

antifungal drugs that inhibit many Cytochrome P450 enzymes INCLUDING CYTOCHROMES USED IN STEROID BIOSYNTHESIS

61
Q

what are the uses of ketoconazole and fluconazole?

A

cushing syndrome

also inhibit androgen synthesis

62
Q

what is the side effect of ketoconazole and fluconazole ?

A

gynecomastia in males

63
Q

what is spironolactone ?

A

corticosteroid receptor antagonist

IT competes with aldosterone for mineralocorticoid –> aldosterone receptor in RENAL TUBES

64
Q

what are the uses of spironolactone ?

A

Potassium sparing diuretic —> we want to keep potassium in

Hyperaldosteronism

Secondary hyperaldosteronism –> due to heart failure ( HF will cause low CO for kindey —> renin —> aldosterone ), bartter syndrome

65
Q

which type primary hyperaldosteronism we use spironolactone ?

A

Primary hyperaldosteronism CAUSED BY BILATERAL ADRENAL HYPERPLASIA

Hyperaldosteronism caused by ALDOSTERONE producing adenoma IS TREATED BY SURGERY

66
Q

what is mifepristone ?

A

Receptor antagonist for progesterone and glucocorticoid

used for cushing syndrome

Pharma S1Y2 (11 decks)

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