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Fundamentals of Pharmacology > Steroids > Flashcards

Steroids Flashcards

1
Q

What is the role of the Medulla?

A
  • Secretes catecholamines (part of ANS)
  • Secretes A and NA
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2
Q

What is the role of the Cortex?

A
  • Secretes mineralcorticoids, glucocorticoids, cortisol and adrenal sex hormones
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3
Q

List the Adrenal Hormones

A
  • Glucocorticoids
  • Mineralcorticoids
  • Androgens
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4
Q

What is the role of Glucocorticoids?

A
  • Cortisol
    • increases blood pressure and blood sugar level and reduces immune responses
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5
Q

What is the role of Mineralcorticoids?

A
  • Aldosterone
    • hormone that causes the tubules of the kidneys to retain sodium and water
      • increases volume of fluid in the body, drives blood pressure up
    • part of RAAS
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6
Q

What is the role of Androgens?

A
  • DHEA
    • natural steroid precursor of testosterone with some activity of its own
    • testosterone (produced by testes and adrenals)
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7
Q

Physiological Effects of Adrenocortical Steroids

What is Glucose Metabolism’s Effect on the Body?

A
  • Stimulates gluconeogenesis
  • Decreases glucose use by tissues
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8
Q

Physiological Effects of Adrenocortical Steroids

What is Protein Metabolism’s Effect on the Body?

A
  • Increases breakdown of protein
  • Increases plasma protein levels
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9
Q

Physiological Effects of Adrenocortical Steroids

What is Fat Metabolism’s Effect on the Body?

A
  • Increase of mobilsation of fatty acids
  • Increase of use of fatty acids
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10
Q

Physiological Effects of Adrenocortical Steroids

What is Anti-Inflammatory action and Immunosuppression Effect on the Body?

A
  • Stabilise lysosomal membranes in inflammatory cells preventing release of inflammatory mediators
  • Decrease of capillary permeability to prevent oedema
  • Depresses phagocytosis
  • Suppresses atrophy of lymphoid tissue
  • Decreases fever
  • Suppresses immune response
  • Inhibits fibroblast activity
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11
Q

Physiological Effects of Adrenocortical Steroids

What is Psychological Effect on the Body?

A
  • Contribute to emotional instability
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12
Q

Physiological Effects of Adrenocortical Steroids

What is Permissive Effect on the Body?

A
  • Facilitates the response of the tissues to humoral and neural influences during trauma and extreme stress
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13
Q

What is the role of the Hypothalamus-Pituitary-Adrenal Axis?

A
  • Cortisol feedsback to the hypothalamus to control release of CRH
  • High levels of cortisol in the blood inhibit release of CRH by the hypothalamus, consequently less ACTH is released by the anterior pituitary, which in turn, causes less cortisol to circulate in the blood
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14
Q

What effects can stress have on the Hypothalamus-Pituitary-Adrenal Axis?

What is HPA a key factor in?

A
  • Stress can have immunosuppressive effects and the hypothalamus-pituitary-adrenal axis (HPA) is a key factor in the neural modulation of the immune system
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15
Q

Describe the Anti-Inflammatory and Immunosuppresive Effects of Glucocorticoids

A
  • Decrease in number of eosinophils, lymphocytes and monocytes
  • Decrease leukocyte migration and phagocytic activity
  • Decrease production of phospholipase A2, prostaglandins, thromboxanes and leukotrienes
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16
Q

What are the Clinical Uses of Glucocorticoids?

A
  • Replacement Therapy
    • For glucocorticoid deficiency: hydrocortisone
    • For mineralcorticoid deficiency: fludrocortisone
  • Anti-inflammatory
    • Short acting: hydrocortisone
    • Intermediate acting: prednisolone
    • Long-acting: dexamethasone
  • Immuno-suppression
  • Treatment of Allergic Disorders
17
Q

What are the Adverse Effects of Glucocorticoids?

A
  • Suppression of HPA
  • Cushing’s Disease (Excess)
  • Psychological and behavioural changes, aggravation of pre-existing psychiatric disorders
  • Impaired wound healing
  • Osteoporosis, muscle weakness and atrophy
  • Fluid retention, oedema, hypertension
  • Increased acid and pepsin secretion
18
Q

What does an Excess of Glucocorticoids lead to?

A
  • Cushing’s Syndrome
19
Q

What does a Deficiency of Glucocorticoids lead to?

Describe this Disease

A
  • Addison’s Disease
  • Primary (Addison’s)
    • caused by adrenal gland disease
    • associated with all 3 hormones deficiency
    • rare disease, most often caused by auto-immune mediated destruction of adrenal cortex
  • Secondary
    • caused by ATCH deficiency
    • associated with glucocorticoid deficiency
20
Q

What are the symptoms of Addison’s Disease?

A
  • Hypoglycaemia
  • Weight loss
  • Weakness
  • GI
  • Bronze pigmentation
  • Postural hypotension
21
Q

What are other effects of Glucocorticoids?

A
  • Growth and cell division
    • inhibit cell division or synthesis of DNA
    • delay the process of healing
    • retard the growth of children
22
Q

What are the long term Adverse Effects of Glucocorticoids?

A
  • Glucose intolerance
  • Acne
  • Hypertension
  • Oedema
  • Susceptibility to infection
  • Myopathy
  • Cataract
  • Peptic Ulcer
  • Suppression of HPA axis
23
Q

Describe the Precautions that can be taken to minimise the Adverse Effects of Long-Term steroid therapy

A
  • Modification of Dose/Dose regimen
    • use short course/low doses
    • use steroid sparing drugs (anti-inflmmatories of non-steroid types such as NSAIDs)
    • withdraw ‘chronic’ steroids slowly
    • give one dose once daily in morning
    • give on alternate days
    • give dose locally
24
Q

What is the process of withdrawal?

A
  1. ‘Cold Turkey’ if glucocorticoid therapy was shorter than 2 weeks
  2. Taper off if glucocorticoid therapy was longer than 2 weeks
  3. Rate of taper should be proportional to duration of therapy
  4. The longer the original therapy, the slower the rate of dose reduction

Restoration of HPA axis is the reason

25
Q

What are Withdrawal Effects of Glucocorticoids?

A
  • Addisonian Crisis
  • Hypotension
  • Muscle tenderness
  • Hypoglycaemia
  • Myalgia and Fatigue
  • Fever
  • Joint Pain
  • Muscle Stiffness

Fundamentals of Pharmacology (21 decks)

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