Wednesday - Adrenal Pharm - Trachte Flashcards
What do you use glucocorticoids for? (as treatment)
immune suppressants vascular disorders renal disorders organ transplant allergies so many things
How do glucocorticoids have anti-inflammatory effects
reduce cox-2
decrease white blood cell concentration
reduce edema
block vasodilation
How are glucocorticoids anti-allergic
block production of histamine and effects of histamine receptor!
how are synthetic glucocorticoids more potent than cortisol?
less protein bound
slower metabolism
higher glucocorticoid effect and less mineral effect
have a flouride group
which glucocorticoid has a lot of mineralcorticoid activity?
fludrocotisone
What are the side effects of taking a lot of glucocorticoids?
cushing syndrome
Glucocorticoid effects on white blood cells
lymphocytes decrease
neutrophils actually increase (because you block extravasation into tissue)
what happens to cortisol if you shotgun a gallon of liquid licorice?
licorice blocks conversion of cortisol to cortisone, so the effects are like cushings
If you are suspecting hypocortisolism, how to you test it?
short ACTH (tetracosactide) test
if you give that and cortisol level goes up, then the adrenals are functioning
if short acth test is sub normal, you do the long test. What does that tell you?
In addison’s, cortisol level would be low always
in secondary insufficiency, increase in cortisol is eventually seen. (delayed response)
2 Ways to determine origin of cushing syndrome
- 24 hour urine. high level confirms you have a lot o’ cortisol
- night salavary cortisol level - if it’s not low, you’ve lot control = cushings
Determine there’s hypercortisolism. What’s the next step?
ACTH level
high = the disease is dependant on ACTH
low = opposite, obviosly
Dexamethasone challenge. How’s it work, ya butt head?
You give dexamethasone. that should inhibit the pathway (CRH and ACTH) and lead to low cortisol.
Test to distinguish between Cushing’s and ACTH secreting tumor
CRH is given.
tumors of pituitary are responsive
Cardiovascular effects of glucocorticoids
positive ionotrope
increase BP
