Steroids

Question 1

2 mechanisms affecting cortisol release

Answer 1

HPA axis
Adrenocorticotropic hormone

Pro-inflammatory cytokines

• ups cortisol;
• cortisol then downs this

Question 2

Cortisol link to Aldosterone and effects?

Answer 2

Cortisol itself has aldosterone-like effects
ACTH also leads to aldosterone release

function:

• increase sodium reabsorption
• increase K+ excretion

AE:

• high sodium reaborption
• • think high H+ excretion, high HCO3- reabsorption
• Metabolic alkalosis, HyperN, HypoK
• edema, HTN, CHF

Question 3

Cortisol effects

Answer 3

Low dose decreases pro-inflammatory stuff by transrepression

• Cytokines, TNF alpha, IL1 IL alot
• Steroid hence
• • PLA2 for AAA production; COX, LOX all gone
• TCR

High dose increases anti-inflammatory stuff

• IL1R antagonist
• beta 2 receptor

Metabolic

• increase Gluconeogenesis
• • then insulin the lipogensis, then glycogen storage
• also lipolysis
• • net increase lipid deposition

Calcium, Nitrogen balance

• Decrease Ca2+ absorption, increase excretion
• negative nitrogen balance;

Anti-inflammatory function

• decrease lymphocytes, WBCs; increase neutrophils tho
• Decrease Type IV HS from transplantation

Question 4

GIMME THE NAMES mason

Answer 4

Cortisone > Hydrocortisone [cortisol] - 0.5 day
Prednisone > Prednisolone - 1 day, 0.3 water
– first line cos short term but low water retention

Methylprednisolone - 1 day, 0 water
Dexamethasone - 3 day, 0 water

Question 5

Cortisol clinical SE

What must take onte

Answer 5

immunosuppressant
- Opportunistic infections

Osteoporosis
Catabolic - Iatrogenic Cushing’s syndrome
- lipid profile, buffalo hump, moon face
- hyperglycaemia

Glaucoma

Edema, HTN, CHF;

Delayed wound healing, skin thinning due to decreased collagen production;

Muscle wasting, Growth retardation;

HPA axis - must taper off or else ACTH suppressed

PUD - cos of steroid function on PG

Psychosis;

Question 6

What is prednisone

Answer 6

Prodrug Drug; before prednisolone active drug