Unit 2: Steroid drugs

Question 1

2 parts of adrenal gland and what they produce

Answer 1

Adrenal Cortex:
Mineralocorticoids
Glucocorticoids
Adrenal androgens

Adrenal Medulla: epinephrine (adrenaline)

Question 2

3 layers of the adrenal cortex

Answer 2

produces 3 steroid hormones (adrenocorticosteroids)

1. Outer layer (zona glomerulosa)
   - Produce mineralocorticoids
   - ->Aldosterone
2. Middle layer (zona faciculata)
   - Produce glucocorticoids
   - ->Cortisol (hydrocortisone)
3. Inner layer (zona reticularis)
   - Produce adrenal androgens
   - ->Dehydroepiandrosterone (DHEA)

Question 3

synthesis of endogenous corticosteroids

Answer 3

1. stress or hypoglycemia –>CRH from hypothalamus
2. CRH binds in anterior pituitary–> ACTH release
3. ACTH binds in adrenal cortex–> corticosteroids for effect on tissues, cortisol=feedback inhibition to hypothaalamus, inhibits CRH & ACTH

Question 4

one major mineralcorticoid

Answer 4

fludrocortisone

Question 5

one major adrenal androgen

Answer 5

DHEA

Question 6

synthesis of aldosterone

Answer 6

Adrenal cortex is stimulated by angiotensin II to release aldosterone
(K+ levels and ACTH can affect the release of aldosterone but to a smaller extent than angiotensin II)

Question 7

synthesis of endogenous mineralcorticosteroid: MOA

Answer 7

Aldosterone binds to mineralocorticoid receptor, activates the receptor and affects gene transcription
Action similar to glucocorticoid receptors but affects different genes

Question 8

3 things that aldosterone acts on

Answer 8

1. sweat and salivary glands
2. Mucosal cells of the intestine
   * *3.active reabsorption of Na+ and associated passive reabsorption of H2O in the distal convoluted tubule of kidney

Question 9

what is the replacement drug for pt’s with addison’s disease?

Answer 9

fludrocortisone: more salt-retaining potency than anti-inflammatory potency
Addisons: body doesn’t produce sufficient adrenal hormones (low cortisol and aldosterone)
Don’t replace with aldosterone due to electrolyte disturbances

Question 10

mineralcorticoids role in CV system, activation of RAAS system causes…

Answer 10

...increased levels of aldosterone
which cause 
-fibrosis in heart and blood vessels
-Vascular remodeling
-Development of congestive heart failure

Question 11

what do you use to prevent damage from RAAS system?

Answer 11

Use mineralocorticoid receptor antagonist to prevent damage from RAAS system, esp. in systolic heart failure patients

Question 12

MOA for glucocorticoids

Answer 12

steroid binds to Intracellular glucocorticoid receptor–>gene transcription–> decrease inflamm. Ctks & increase Annexin A1 (endothelium)
-takes hours to days

Question 13

pattern of cortisol release

Answer 13

from adrenal cortex in circadian diurnal pattern. Highest levels release early in the morning (peaking around 8am)
Lowest levels released between 12 to 4 am
*GREATLY increased in response to stress.
(Carbohydrate and Protein Metabolism
Lipid Metabolism
Decrease bone formation
Anti-inflammatory
Immunosuppressive)

Question 14

carb and protein metabolism of glucose

Answer 14

1. inc. glucose formation
2. reduce glucose uptake & utilization by peripheral tissues (cortisol antagonizes effect of insulin)
3. inc. protein breakdown (catabolic effect)
4. activate lypolysis (provides fatty acids for glucose formation) inc. free fatty acids = insulin resistance

Question 15

outcomes of carb and protein metabolism of glucose

Answer 15

Outcomes from these effects:
Decreased muscle mass
Thinning of the skin
Hyperglycemia
Worsening of diabetes