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Pharma S1Y2 > Steroid hormones > Flashcards

Steroid hormones Flashcards

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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
what is the newest agent for allergic rhinitis ?
ciclesonide
26
what are the agents for asthma ?
triamiclnolone budesonide ciclesonide flunisolide mometasone flucticasone
27
why are glucocorticoids used in cancer?
lymphotoxic effects used in lymphocytic leukemia and lymphomas
28
why is dexamethasone used in combination with other drugs for cancer?
it prevents emesis during cancer chemotherapy
29
what is the drug used in respiratory distress syndrome ?
betamethasone ---> long acting
30
why is betamethasone the drug choice for respiratory distress syndrome?
it is used in premature infants and it acts by promoting fetal lung maturation in the same manner as endogenous cortisol
31
what hormones are deficient in primary adrenal insufficiency ?
cortisol aldosterone androgens
32
what hormones you have to give in primary adrenal insufficiencies ?
Fludrocortisone ----> for aldosterone hydrocortisone --> for cortisol
33
what hormones are deficient in secondary adrenal insufficiency ?
cortisol and androgens ALDOSTERONE IS NORMAL secondary adrenal insufficiency is usually due to prolonged administration of corticoids and ACTH deficiency
34
what hormones you have to give secondary adrenal insufficiency ?
you only give cortisol ---> hydrocortisone /glucocorticoids no need for fludrocortisone cuz no aldosterone deficiency
35
what is acute adrenal insufficiency?
aka adrenal crisis, addisonian crisis medical emergency that happens when someone is under stress but there are not corticoids to help him
36
how do you treat acute adrenal insufficiency ?
IV hydrocortisone 48 hours followed by long term oral hydrocortisone
37
how is chronic adrenal insufficiency treated?
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
what is congenital adrenal hyperplasia? CAH
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
why do we have adrenal hyperplasia in cases of CAH?
cuz impaired synthesize of cortisol and aldosterone will result in increased ACTH --->Hyperplasia
40
what are the characteristics of CAH?
since theres a shift towards production of adrenal androgens ---> virilization -----> masculinization ----> in girls pseudo hermaphroditism ----> in girls
41
what is the commonest enzyme defect in CAH?
21 hydroxylase --> 90% of the cases 11b hydroxylase ----> 9% of the cases
42
how is CAH treated?
hydrocortisone to stop ACTH secretion fludrocortisone to treat aldosterone deficiency
43
how do you treat cushing syndrome due to excessive levels of ACTH?
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
how is cushing syndrome diagnosed ?
free cortisol levels in the urine dexamethasone suppression test person with cushing syndrome dexamethasone will not suppress corticotropin ( ACTH ) secretion
45
what are the dermatologic conditions where you use corticosteroids ?
Atopic ( contact ) sberrheic dermatitis pruritus --> itching psoriasis sunburn
46
on which part of the skin you use low potency drugs?
areas of thin skin ----> face and eyes intertriginous areas where skin is folded or overlapped
47
which part of the skin you use medium potency drugs?
ear trunk Arm legs scalp
48
which part of the skin you use high potency drugs?
palms and soles
49
what are the low potency TOPICAL STEROIDS?
hydrocortisone --> cortisol desonide hydrate under de Sun
50
what are the medium potency topical steroids ?
Triamcinolone fluticasone Try the flute
51
what are the high potency steroids?
desoximetasone fluocinonide Remove your socks ( de sox ) when you have flu
52
what are the very high potency steroids ?
betamethasone dexamethasone clobetasol A BCD ( Beta clobe dexa )
53
what are the other uses of glucocorticoids ?
hypercalcemia sarcoidosis immunosuppressants to prevent organ rejection
54
what are the side effects of long term uses of glucocorticoids ?
Symptoms of cushing syndrome moon face Brusing peptic ulcer hypertension centripetal obesity Striae menstral disturbance Etc
55
what is the major Adrenal androgen and whats its major use?
Dehydroepiandrosterone DHEA major androgen secreted by the cortex extremely weak androgen ---> converted to testosterone NO CLINICAL USE
56
what is aminoglutethimide ?
corticosteroid synthesis inhibitor that inhibit P450SCC stops conversion of cholesterol to pregnenolone
57
what are the uses of aminoglutethimide?
it inhibits all steroids Breast cancer malignant adrenocortical tumors Cushing syndrome along with metyrapone
58
what is metyrapone ?
corticosteroid synthesis inhibitor that inhibit 11B hydroxylase enzyme it inhibits aldosterone / cortisol pathway and shifts it all to androgen pathway
59
what are the uses of metyrapone ?
cushing syndrome along with aminoglutethimide me tired ill sleep on the cushion
60
what are ketoconazole and fluconazole ?
antifungal drugs that inhibit many Cytochrome P450 enzymes INCLUDING CYTOCHROMES USED IN STEROID BIOSYNTHESIS
61
what are the uses of ketoconazole and fluconazole?
cushing syndrome also inhibit androgen synthesis
62
what is the side effect of ketoconazole and fluconazole ?
gynecomastia in males
63
what is spironolactone ?
corticosteroid receptor antagonist IT competes with aldosterone for mineralocorticoid --> aldosterone receptor in RENAL TUBES
64
what are the uses of spironolactone ?
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
which type primary hyperaldosteronism we use spironolactone ?
Primary hyperaldosteronism CAUSED BY BILATERAL ADRENAL HYPERPLASIA Hyperaldosteronism caused by ALDOSTERONE producing adenoma IS TREATED BY SURGERY
66
what is mifepristone ?
Receptor antagonist for progesterone and glucocorticoid used for cushing syndrome

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