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MPT > Test 5 > Flashcards

Test 5 Flashcards

1
Q

What are hormones?

A

Chemical regulators of cellular function

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2
Q

Where are hormones synthesized?

A

Endocrine glands

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3
Q

What happens after hormones are produced?

A

They are put into circulation (released)

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4
Q

How do hormones act on target tissues?

Through what?

A

Through specific receptors

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5
Q

What are the three types of hormones?

A

Amino acid based hormones
Eicosanoids
Steroidal hormones

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6
Q

What kind of hormones are insulin, GH, and catechols?

A

Amino acid based hormones

These are AAs, peptides, proteins, and catecholamines

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7
Q

What kind of hormones are prostaglandins?

A

Eicosanoids

Locally acting and locally secreted

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8
Q

What kind of hormones are adrenocortical and gonadal hormones?

A

Steroids

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9
Q

What are steroids deratives of?

A

Cholesterol

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10
Q

What kind of steroid hormones are cortisol and aldosterone?

A

Adrenocortical hormones

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11
Q

What kind of steroid hormones are estrogen and testosterone?

A

Gonadal hormones

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12
Q

What kind of receptors do steroidal hormones act on?

A

Intracellular/nuclear hormones

They are lipid soluble so pass through membrane

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13
Q

Which acts faster, plasma membrane receptors or intracellular receptors?

A

Plasma membrane receptors

They do not have to do with gene transcription which is slow

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14
Q

What kind of responses would steroid hormones produce when binding to a receptor?

A

Gene suppression or activation

Also thyroid hormones as well

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15
Q

How does a steroid get to the intracellular receptor?

A

Pass through plasma membrane into the cytosol and bind to intracellular receptor to form the hormone receptor complex

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16
Q

How do steroids affect gene transcription activity?

A

The hormone receptor complex interacts with DNA and affects gene transcriptional activity to cause transcription of mRNA and Synthesis or translation of protein

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17
Q

Are steroidal hormones packaged?

A

No they are synthesized and immediately released

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18
Q

Where are the enzymes that produce steroids located?

A

Mitochondria and smooth ER

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19
Q

How do hormones get transported throughout the body?

A

Bound to binding globulins to get transported by the blood

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20
Q

What binding globulin carries cortisol?

A

Corticosteroid binding globulin

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21
Q

What globulin carries estradiol and testosterone?

A

Sex steroid Binding globulin

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22
Q

What converts steroids to active form if they are not already activated?

A

The target cell

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23
Q

What are the three main roles of steroidal hormones in physiological function?

A

Carbohydrate regulation
Mineral balance
Reproductive steroids

Glucocorticoids
Mineralocorticoids
Gonadal steroids

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24
Q

What kind of steroid helps with inflammation response, stress response, bone metabolism, behavior and mood?

A

Glucocorticoids

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25
Q

What is the hypothalamus made up of?

A

Neurosecretory hormone secreting cells of the posterior pituitary via the infudibular stalk

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26
Q

What does the hypothalamus do?

A

Release releasing and inhibiting factors that act on cells in the anterior pituitary via the hypopheseal portal system

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27
Q

What is the pituitary made up of?

A

Cells that produce hormones that are released into the blood stream

Anterior and posterior sections have different functions

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28
Q

What is the posterior pituitary comprised of?

A

The endings of axons from cell bodies in the hypothalamus that are released into the posterior pituitary

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29
Q

What are the principal hormones of the posterior pituitary?

A

ADH/ vasopressin
Oxytocin

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30
Q

What does ADH do?

A

Regulate fluid levels (increase water reabsorption in the kidneys)

This would increase blood pressure- also called vasopressin

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31
Q

What does oxytocin do?

A

Cause milk ejection and uterine contraction

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32
Q

How are the hypothalamus and pituitary gland connected?

A

Via blood vessels that converge at the median eminence at the base of the hypothalamus

Hypophyseal portal system

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33
Q

What is released from the hypothalamus?

A

Releasing factors
Inhibiting hormones

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34
Q

What do releasing hormones do?

A

Cause release of hormones by the anterior pituitary

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35
Q

What do inhibiting hormones do?

A

Inhibit secretion of hormones by the anterior pituitary

DA
Somatostatin

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36
Q

What are the Anterior pituitary hormones?

A

ACTH
GH
Prolactin
TSH
FSH
LH

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37
Q

What does ACTH do?

A

Stimulates cortisol secretion by adrenal cortex

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38
Q

What is CRF/CRH?

A

Corticotropic releasing factor/hormone

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39
Q

What does CRF do?

A

Regulates ACTH secretion from Anterior pituitary which causes release of cortisol into the blood

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40
Q

What stimulates release of ACTH?

A

CRF or CRH release

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41
Q

What inhibits CRH?

A

ACTH and cortisol

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42
Q

What inhibits ACTH?`

A

Cortisol

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43
Q

What is hyposecretion?

A

Too little of the hormone produced

Less than normal response

Hypothyroidism

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44
Q

What is hypersecretion?

A

Excess hormone produced

exaggeration of normal effect

Hyperthyroidism

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45
Q

What is the primary pathology of hormone secreting glands?

A

Damage to hormone secreting glands

Tumor or death cells
Addison’s
CAH

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46
Q

What kind of disease is Addison’s Disease?

A

An autoimmune

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47
Q

What kind of disease is adrenal hyperplasia?

A

Autosomal abnormality

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48
Q

What is the secondary pathology caused for hypersecretion?

A

Damage to the control systems and mechanisms

Caused by pituitary adenomas

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49
Q

What happens/side effects are caused by Hyperpituitarism?

Adenomas

A

Visual field changes
Increased intraocular pressure

Pushes the optic neuronal tracks
Effects ACTH, GH, and prolactin

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50
Q

What causes hypopituitarism?

A

Destruction of the pituitary

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51
Q

What is the most common cause of destruction of the anterior pituitary?

A

Panhypopituitarism

Loss of AcTH, TSH and is life threatening

Non secretory pituitary adenomas

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52
Q

What are the layers of the adrenal cortex?

A

Zona glomerulosa- outer
Zona fasciculata- middle
Zona reticularis- inner

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53
Q

What is produced by the adrenal cortex?

A

Steroid hormones

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54
Q

What does the zona reticularis produce?

A

Gonadal steroids

Adrogens to be converted to estrogens in females

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55
Q

What does the zona glomerulosa produce?

A

Mineralocorticoids

Ion
H2O balance
Aldosterone

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56
Q

What does the zone fasciculata produce?

A

Glucocorticoids

Glucose metabolism
Cortisol

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57
Q

What does cortisol do for the body?

A

Helps with blood glucose levels unders stress
Increase gluconeogenesis also in the liver
Decrease the immune response

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58
Q

What is cortisol stimulated by?

A

CRH and ACTH

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59
Q

When is cortisol produced?

Under what body condition

A

Stress

Low plasma glucose concentration

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60
Q

What are the actions of glucocorticoids mediated by?

What receptor

A

Glucocorticoid receptor

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61
Q

What super family is the human Glucocorticoid receptor under?

A

Transcription factor proteins

Steroid, thyroid, retonic acid nuclear receptor superfamily

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62
Q

What do these transcription factors do?

A

Regulate the expression of glucocorticoid responsive element GRE either positively or negatively

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63
Q

What happens when the GR is activated?

A

Receptors translocate to the nucleus to alter gene transcription by binding to specific response elements

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64
Q

What are glucocorticosteroids blocked by?

A

11 Beta HSD
Inactivates them

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65
Q

What is the inactive form of cortisol?

A

Cortisone

66
Q

From studies of GR knock out in mice, what is GR necessary for?

A

Lung development for producing surfactant
Regulation of liver, adrenal glands, brain, and HPA axis

67
Q

What kind of regulatory hormone are glucocorticoids?

In terms of biological effects on carbs, proteins and lipids

A

Significant counter-regulatory hormone to insulin

68
Q

What do glucocorticoids do for the carbohydrates, proteins, and lipid metabolism?

A

Mobiize amino acids for hepatic gluconeogenesis
Increase blood glucose concentration
Increase lipolysis in adipose tissue
Inparts insulin resistance cells and increasing permissiveness

69
Q

What do glucocorticoids do for the skin?

A

Regulate epithelial integrity and immune function

70
Q

What are Glucocorticoids used for to treat the skin?

A

Inflammation caused by eczema, hives, allergies, and psoriasis

Side effects- skin atrophy, and delayed wound healing

71
Q

What do glucocorticoids do for circulation?

A

Maintains body fluid volumes and vascular integrity

Sensitizes arterioles to action of NE

Decrease capillary permeability
Maintain normal renal function
Minaralocorticoid effects from cortisol

72
Q

What does cortisol do for blood pressure?

A

It increases blood pressure by sodium retention and volume expansion

Intrinsic mineralcorticoid activity
Increase vascular smooth muscle sensitivity
Decrease NO
Increases RAAS

73
Q

What does cortisol do for calcium metabolism?

A

Inhibits osteoblastic function

Decreases the ability to add new bone

Causes osteoporosis and osteopenia

74
Q

What is Addison’s disease caused by?

A

Cortisol insufficiency

75
Q

What is primary Addison’s disease caused by?

A

Cortisol insufficiency due to the loss of ability to make cortisol in adrenal gland

Increases ACTH levels and there is no feedback
Increase in MSH

Hyper pigmentation

76
Q

What is secondary Addison’s disease caused by?

A

Decrease in ACTH

Decrease CRH

Loss of function in hypothalamus

Rapid withdraw from steroids

77
Q

What might cause Addisonian Crisis?

A

Adrenal insufficiency

Weakness
Fatigue
Hypotenion
GI probs
Hypoglycemia

Increase in K decrease in NA

78
Q

What might cause Addisonian Crisis?

A

Adrenal insufficiency

Weakness
Fatigue
Hypotenion
GI probs
Hypoglycemia

Increase in K decrease in NA

79
Q

What causes Cushing’s Syndrome?

A

Hypersecretion of ACTH and Cortisol

80
Q

What causes an increase cortisol release

A

Tumor

81
Q

What causes an increase in ACTH release?

A

Tumor in lungs, pituitary gland, kidneys, and pancreas

82
Q

What causes ectoptic release by neoplasias?

A

Lung cancer

83
Q

What causes Iatrogenic Cushing’s Syndrome?

A

Exogenous Glucocorticosteroid Administration

84
Q

What does excess release of GCs cause?

A

Osteoporosis
Cataracts
Skin thinning/ cutaneous striae
Decrease proteins and myopathies
Connective tissue breakdown
Blood changes
CNS effects

85
Q

How does Cushing’s disease affects lipid distribution?

A

Causes an increase in weight
Trunkal obesity
Moon facies
Buffalo hump

86
Q

What happens to the skin in Cushing’s Disease?

A

Fragility
Easy bruising “cutaneous striae”

87
Q

What does Cushing’s disease do when an infection occurs?

A

Masks them through anti inflammatory actions

88
Q

What does cushing’s syndrone cause metabolically?

A

Water and salt retention
Increased glucose concentration
Increased osteoclasts and decreased osteoblasts

Hypertension
Hyperglycemia “steroidal diabetes”
Bone atrophy muscle too

89
Q

What are glucocorticoids mainly used for?

A

Their anti-inflammatory effects

90
Q

What does glucocorticoid use do to the production of eosinophils and prostaglandins?

A

Inhibit them

91
Q

What enzyme do glucocorticoids inhibit to stop the production of prostaglandins?

A

Phospholipase A2

92
Q

What are the ways glucocorticoids cause decrease in inflammation?

A

Inhibit phospholipase A2
Decrease permeability of capillary membranes
Decrease swelling
Decrease histamine effect

93
Q

How do glucocorticoids suppress the immune system?

A

Decrease Tcell and antibody production
Decrease eosinophils and lymphocytes
Inhibit macrophage and neutrophil function
Decrease immunity

94
Q

When would inhaled glucocorticosteroids be prescribed ?

What disease state

A

Asthma
Chronic respiratory inflammation

95
Q

How do inhaled glucocorticosteroids inhibit the inflammatory response of asthma?

A

Inhibit NF-kV and activator protein 1 activity which is a transcription factor

Decrease production and secretion of cytokines, chemokines,cell adhesion

96
Q

What are glucocorticoid agonists used for?

A

Adrenal insufficiency
Inflammatory disorders
Autoimmune disorders

Addison’s
Asthma/skin
RA, IBS, MS

97
Q

When are glucocorticoid antagonists used?

A

Cushing’s disease or syndrome

98
Q

What is the primary naturally occuring steroid in the body?

A

Hydrocortisone

Taken orally

99
Q

What is the prodrug for prednisolone?

A

Prednisone

100
Q

When is prednisolone usually chosen?

A

Chosen for anti-inflammatory

Little sodium retention

101
Q

What kind of glucocorticosteroid is Triamcinolone?

A

Flurinated glucocorticosteroid

No sodium retaining effect

102
Q

Triamcinolone has a serious adverse effect, what is it and what is a good part of triamcinolone at lower doses?

A

Bad- causes muscle wasting
Good- low sodium retention

103
Q

What two drugs are usually chosen over prednisolone because they are longer acting?

A

Dexamethasone
Betamethasone

104
Q

When would you use glucocorticoid for replacement therapy?

A

Acute adrenal insufficiency
Chronic adrenal insufficiency (addison’s)
Congential adrenal hyperplasia (autosomal)

105
Q

What is the main problem with using glucocorticoids for non endocrine disorders?

A

They have good effects but the same amount of side effects

106
Q

What kind of steroid is aldosterone?

A

Mineralocorticoid

No place in routine therapy
too much first pass metabolism
used for sodium retention

107
Q

What is used instead of aldosterone in practice?

A

Fludrocortisone

Large sodium retention

long acting flourinated

Replace aldosterone where adrenal cortex is destroyed (addisons)

108
Q

What does long term use of corticosteroids do?

A

Cause long term suppression of the HPA axis so they need to be tappered off

109
Q

What is addisonian crisis?

A

Acute adrenocortical insufficiency
Emergency

110
Q

What is the most common cause of Adrenal crisis?

A

HPA axis suppression / abrupt with drawal

111
Q

What can treat Addison’s?

A

Hydrocortisone
Prednisone

112
Q

What is the goal in treating addisons disease?

A

Establish an effective dose while mimicking normal diurnal adrenal rhythm (cortisol is highest in the morning)

113
Q

Why is hydrocortisone used the most to treat addison’s disease?

A

Because it has both mineralocorticoid and glucocorticoid activity and in addison’s disease aldosterone is lost too

114
Q

What happens in cushing’s syndrome?

A

Too much cortisol either exogenously or endogeneously

115
Q

What is their too much of in ectopic or lung tumors?

A

ACTH

116
Q

What kind of tumors cause too much cortisol?

A

Adrenal tumors

Adrenal hyperplasia

117
Q

WHat is the most common way to diagnose chushings?

A

The 24 hours urinary free- cortisol test

Collect urine over 24 hours and test cortisol levels
IF high then yes

118
Q

What are the three main forms of treatment for cushings?

A

Surgery of tumor
Radiation Therapy
Medications

119
Q

What medications are used to treat cushings?

A

Steroidogenic inhibitors

120
Q

What do steroidogenic inhibitors do?

A

Uses medications that inhibit enzymes required for synthesis of corticosterone and cortisol

Inhibition of 11 beta hydroxylase

121
Q

What is Metyrapone used for?

A

Cushings disease

122
Q

What does metyrapone do?

A

Inhibits 11 beta hydroxylase in the adrenal gland

123
Q

What does Osilodrostat do?

A

Inhibition of 11 beta hydroxylase

For those who cannot have surgery or it did not work

124
Q

What does ketoconazole do?

A

Normally for fungal infections
Inhibits the P450 enzyme system which then inhibits the 11 Beta hydroxylase

125
Q

What does Mitotane do?

A

Inhibits 11 hydroxylation and pregenolone synthesis from cholesterol in. thecortex

Could have life threatening side effects since it is an anti neoplastic agent

126
Q

What is Pasireotide?

A

Somatostatin analog that is universillay an inhibitor

127
Q

what does Pasireotide do?

A

Acts via somatostatin receptors to inhibit secretion of corticotropin from pituitary adenomas with Cushings disease

Somatostatin receptor type 5?

128
Q

what does Pasireotide do?

A

Acts via somatostatin receptors to inhibit secretion of corticotropin from pituitary adenomas with Cushings disease

Somatostatin receptor type 5?

129
Q

What is the main side effect of Pasireotide?

A

Hyperglycemia

130
Q

What kind of effect do topical steroids have?

A

Topical anti inflammatory effect

131
Q

What are the main topical steroids?

A

Hydrocortisone
Prenisolone and methylpred
Dexa and Betamethasone
Triamcinolone
Fluocinonide

132
Q

How war topical steroids ranked?

A

In classes from 1 to 7 based on potency with 1 being the most potent

133
Q

What do ointments treat?

A

Dry thick lesions

134
Q

What kind of effect do creams have?

A

Anti inflammatory with a little bit of drying

Good for sensitive areas

135
Q

What kind of agent are lotions and gels?

A

Occlusive and they have alcohol so drying as well

Good on hair

136
Q

What potency should you use on the face?

A

Decrease side effects by lowering the potency

137
Q

What are side effects related to?

A

Frequency
Potency
Duration of use
Anatomical site of application

138
Q

what is Asthma?

A

Chronic inflammatory disease of airways (bronchials) increase in responsiveness allergens

139
Q

WHat are the features of asthma?

A

Inflammation of bronchial walls and inflammation cell infiltration
Reversible airflow obstruction
Increase in mucous

140
Q

When do asthma attacks normally occurr?

A

At night

141
Q

What are the immune responses you see with asthma?

A

Inflammatory cell infiltration
Mast cell activation
Edema
Denudation of airway epithelium
Collagen deposition beneath the basement membrane

142
Q

What causes Atopy?

A

Too much IgE

Inflammation response

143
Q

What kind of response is the early phase of airway inflammation?

A

Bronchospasm Response
release of inflammation mediators from mast cells macrophages and epithelials

144
Q

What kind of inflammation happens in the secondary dip for asthma attacks?

A

Chemotactic inflammation

145
Q

What are the primary mediators?

A

Histamine

146
Q

What are the secondary mediators?

A

Leukotrienes
Prostaglandins

147
Q

What does the mediator soup cause?

A

Bronchoconstriction
Microvascular Leakage
Mucus Hypersecretion
Airways Hyperresponsiveness

148
Q

What kind of steroids are used as quick relief medications for asthma?

A

Systemic steroids
Oral or IV

Gain control of moderate to severe acute exacerbations

149
Q

What are the two main systemic steroids?

A

Prednisone and prednisolone

Acutely speed resolution of airflow obstruction

150
Q

What is used for controller medications for asthma?

A

Inhaled Glucocorticoids

151
Q

What must be taken with LABAs?

A

Inhaled Glucocorticoids

MOmetasone
Fluticasone

152
Q

What do inhaled glucocorticoids do?

A

Decrease Bronchial Hyperreactivity

Decrease dependency on SABAs for sympathetic relief
Increase pulmonary function
Increase quality of life

153
Q

What is the mechanism of action of inhaled corticosteroids?

A

Suppress cytokine production
Decrease eosinophil function
Inhibits macrophages and release of cytokine inflammation
Stablizes endothelial membranes

154
Q

What are the respiratory corticosteroid inhalation products?

A

Budesonide
Ciclesonide
Beclomethasone Dipropionate
Mometasone

155
Q

Why is Flonase good for inhalation?

A

It is rapidly metabolized by the liver (3A4) so it has little systemic side effects if swallowed

156
Q

What are the main side effects of inhaled corticosteroids?

A

Deposition in mouth and throat that may increase oral candidiasis
Stop this by rinsing after use

157
Q

Why do you not use ICS for COPD?

A

The side effects outweigh the benefits

158
Q

What cell types are found in asthma?

A

Mast cells
Eosinophils
CD4+ T cells
Macrophages

159
Q

What cell types are found in COPD?

A

Neutrophils
CD8+
T cells
Many macrophages

160
Q

What effects are different between COPD and Asthma?

A

Asthma only effects bronchials and then COPD effects bronchials and alveoli

MPT (5 decks)

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