Unit 10: Corticosteroids Flashcards
What stimulates the adrenals to release cortisol?
ACTH
What releases ACTH?
The anterior pituitary
What stimulates the kidneys to retain sodium and therefore water?
ADH
What releases ADH?
The posterior pituitary
What kind of steroid is cortisol?
GLUCOcorticoid
What kind of steroid is aldosterone?
MINERALOcorticoid
What do the glucocorticoids do?
metabolism function
immune function
What do the mineralocorticoids do?
regulate fluids, electroltytes
What is another name for cortisol?
hydrocortisone
What is CBG?
cortisol binding globulin
When are levels of CBG higher?
pregnancy
increased estrogen
hyperthyroidism
What happens to cortisol when CBG levels go up?
less cortisol available
When are levels of CBG lower?
protein deficiency
hypothyroidism
genetic defect in synthesis of CBG
What happens to cortisol when CBG levels go down?
more cortisol available
What intracellular effects do corticosteroids have?
growth pro-inflammatory cytokines immune activity insulin amount and action glucagon catecholamine response ACTH
What does cortisol do?
FASTING: stimulates gluconeogenesis and glycogen synthesis
muscle catabolism
increases serum glucose –> provides continuous supply of glucose to the brain
increases insulin secretion
changes in fat metabolism
increased fatty acids in serum
Why does a person on prednisone have higher WBC counts but decreased response to infection?
prednisone increases # of neutrophils by releasing more from bone marrow, but keeps them in the serum and does not allow them to go to the area of inflammation
What effect does cortisol have on macrophages?
macrophages are cells that eat bacteria
steroids inhibit them
What effect does cortisol have on prostaglandins?
reduces prostaglandins synthesis –> reason steroids can be helpful in arthritis
What effect does cortisol have on mood?
depression
insomnia
What effect does cortisol have on the head?
increases intracranial pressure (psuedotumor cerebri)
What effect does cortisol have on other hormones from the pituitary?
increases ACTH GH TSH LH
What happens if cortisol is given in pregnancy?
mood disorders in the child
What effect does cortisol have on the GI tract?
reduced prostaglandin synthesis –> decrease in mucous production
Suffix of all synthetic corticosteroids
-one
Divide the synthetic corticosteroids into short-acting, intermediate-acting, and long-acting
SHORT: hydrocortisone cortisone prednisone prednisolone methylprednisone
INTERMEDIATE:
trimacinolone
LONG:
betamethasone
dexamethasone
What is the DOC for patients with hepatitis and why?
prednisolone (not metabolized by the liver)
What do corticosteroids have to do with vaccinations?
decrease the immune response
do not give the vaccination until the person is on less than 20mg/day
What happens to the mood/sleep of patients on corticosteroids?
can’t sleep
“all revved up”
Why do we use a taper with steroids?
- steroids help maintain BP; decreasing the dose too quickly can cause hypotension
- sometimes, steroids need to be continued for the duration of the illness (e.g. poison ivy)
What happens to skin and bone in patients on steroids for more than 2 weeks?
bone demineralization
acne
avascular necrosis
What do steroids do to wound healing?
delay it
What causes Iatrogenic Cushing’s?
lots of steroids for a long time
typically 100mg/day for > 2 weeks
Symptoms of Iatrogenic Cushing’s?
face rounding
puffiness
truncal obesity
thin extremities
Describe adrenal suppression with steroids
when patients are on steroids, their adrenals won’t make their own steroids
What is stress dosing for trauma/surgery?
double the dose for 24-72h to help maintain BP and nutrition for surgery
Name some inhibitors of adrenocorticoid synthesis
metyraprone
aminoglutethimide
What are metyraprone and aminiglutethimide used to treat?
Cushing’s (adrenal excess)
What typically causes Cushing’s syndrome?
ACTH or cortisol producing tumor
What effects does aldosterone have?
promotes reabsorption of Na+ and therefore water
promotes K+ and H- excretion
What is fludrocortisone?
pharmaceutical version of aldosterone
What is fludrocortisone used for?
adrenal insufficiency associated with mineralocorticoid deficiency
POTS/fainting
Name some aldosterone antagonists
spironolactone
eplerenone
drospirenone
For what is spironolactone used?
a potassium-sparing diuretic with several indications: primary aldosteronism (Cushing’s)
heart failure
edema from liver cirrhosis with ascites and nephrotic syndrome
Hirsutism/PCOS
Acne
For what is eplerenone used?
HTN/CHF
What is Carospir?
liquid version of spironolactone taken by children
main side effect of spironolactone?
hyperkalemia
What is Addison’s disease?
chronic primary adrenal insufficiency
Symptoms of Addison’s Disease
myalgia arthralgia articular cartilage calcification weakness hypotension weight loss salt cravings brown hyperpigmentation of sun exposed skin manic episodes anemia hyponatremia hypokalemia
Treatment of Addison’s disease
hydrocortisone/dexamethasone
fludrocortisone –> to maintain BP/fluid balance
other hormone replacement
medications contraindicated in Addison’s Disease
spironolactone
diuretics
