Term
| How do mineralcorticoids act? |
|
Definition
| stimulate mineralocorticoid receptors |
|
|
Term
| What is a natural mineralcorticoid? |
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Definition
|
|
Term
| What is a synthetic mineralcorticoid? |
|
Definition
| fludrocortisone (florinef) |
|
|
Term
| What class of corticosteroid agonsists maintains Na+, K+ balance? |
|
Definition
|
|
Term
| What are 3 types of corticosteroid agonists? |
|
Definition
| mineralcorticoids, glucocorticoids, adrenal androgens |
|
|
Term
| How do glucocorticoids act? |
|
Definition
| stimulate glucocorticoid receptors |
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Term
| What is a natural glucocorticoid? What is it's drug equivalent? |
|
Definition
| cortisol (hydrocortisone is drug equivalent) |
|
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Term
| The following are synthetic products of what corticosteroid agonist: prednisone, dexamethasone, etc.? |
|
Definition
|
|
Term
| Regarding the hypothalamic-pituitary-adrenal axis, what is released in response to stress? |
|
Definition
| corticotropin-releasing hormone in hypothalamus |
|
|
Term
| Regarding the hypothalamic-pituitary-adrenal axis, what is released in response to stimulation by crh? |
|
Definition
| corticotropin (acth) from the pituitary gland |
|
|
Term
| Regarding the hypothalamic-pituitary-adrenal axis, what is released in response to stimulation of acth? |
|
Definition
| cortisol from the adrenal gland |
|
|
Term
| Regarding the hypothalamic-pituitary-adrenal axis, how does cortisol provide feedback? |
|
Definition
| inhibition of crh and acth release |
|
|
Term
| What is released in basic physiologic processes in the amount of 20-30 mg/day and under stress in the amount of 200-300 mg/day? |
|
Definition
|
|
Term
| What corticosteroid agonist will cause a rise in blood sugar? What is the mechanism for this rise? |
|
Definition
| glucocorticoids stimulates gluconeogenesis: stimulates insulin release |
|
|
Term
| Which corticosteroid agonist stimulates lipolysis and abnormal fat distribution? |
|
Definition
|
|
Term
| What are 2 metabolic effects of glucocorticoids? |
|
Definition
| stimulates gluconeogenesis, stimulates lipolysis and abnormal fat distribution |
|
|
Term
| What are catabolic effects of glucocorticoids? |
|
Definition
| wasting of mm, connective tissue, skin, and bone. |
|
|
Term
| Catabolic effects, immunosuppression, and anti-inflammatory effects are what type of effects from what class of corticosteroid agonists? |
|
Definition
| physiological effects of glucocorticoids |
|
|
Term
| What corticosteroid agonist causes wasting of mm, connective tissue, skin, and bone? |
|
Definition
| catabolic effects of physiological effects of glucocorticoids |
|
|
Term
| What is the mechanism for the immunosuppressive effects of glucocorticoids? |
|
Definition
| inhibits t and b lymphocyte activity and Ag-presenting cells such as macrophages. |
|
|
Term
| What corticosteroid agonist inhibits t and b lymphocyte activity and Ag-presenting cells such as macrophages? |
|
Definition
| immunosuppressive physiologic effects of glucocortiocoid |
|
|
Term
| How do glucocorticoids produce an anti-inflammatory effect? |
|
Definition
| effect on lymphocytes and leukocytes casues a reduction in circulating cytokines, histamines, and prostaglandins which mediate inflammation |
|
|
Term
| What corticosteroid agonist has an effect on lymphocytes and leukocytes casues a reduction in circulating cytokines, histamines, and prostaglandins which mediate inflammation? |
|
Definition
| anti-inflammatory physiological effect of glucocorticoid |
|
|
Term
| What are 6 clinical uses for glucocorticoids? |
|
Definition
| 1. primary adrenal insufficiency (addison's disease). 2 acute and chronic inflammation (ibd, asthma, psoriasis, arthritis) 3. allergic rxns (drug rxns, angioedema), 4. autoimmune disorders (polymyalgia, rheumatica, sle, polymyositis) 5. leukemias and lymphomas. 6. organ transplants |
|
|
Term
| What sp drugs can be used to tx addison's disease? |
|
Definition
| physiologic doses of hydrocortisone and fludrocortisone |
|
|
Term
| With what class of drugs can the following be tx: ibd, asthma, psoriasis, arthritis? |
|
Definition
| acute and chronic inflammation: glucocorticoids |
|
|
Term
| With what class of drugs can the following be tx: drug rxns, angioedema? |
|
Definition
| allergic rxns: glucocorticoids |
|
|
Term
| With what class of drugs can the following be tx: polymyalgia, rheumatica, sle, polymyositis? |
|
Definition
| autoimmune disorders: glucocorticoids |
|
|
Term
| High doses or prolonged tx can cause what adr's in the adrenal gland? |
|
Definition
| adrenal atrophy, cushing's |
|
|
Term
| High doses or prolonged tx can cause what adr's in the cardiovascular system? |
|
Definition
|
|
Term
| High doses or prolonged tx can cause what adr's in the cns? |
|
Definition
| steroid-induced psychosis |
|
|
Term
| High doses or prolonged tx can cause what adr's in the gi tract? |
|
Definition
|
|
Term
| High doses or prolonged tx can cause what adr's in the immune system? |
|
Definition
| immunosuppression, infections |
|
|
Term
| High doses or prolonged tx can cause what adr's in the integument? |
|
Definition
| skin atrophy, delayed wound healing |
|
|
Term
| High doses or prolonged tx can cause what adr's in the musculoskeletal system? |
|
Definition
| mm atrophy, osteoporosis (almost all the time w/extensive use), delayed growth |
|
|
Term
| High doses or prolonged tx can cause what adr's in the eyes |
|
Definition
|
|
Term
| High doses or prolonged steroid tx can cause what adr's in the kidney? |
|
Definition
| Na+ retention and K+ excretion |
|
|
Term
| High doses or prolonged tx can cause what adr's in the reproductive system? |
|
Definition
| hypogonadism, delayed puberty |
|
|
Term
| What is the usual cause of acute adrenal insufficiency? |
|
Definition
| usually secondary to hpa axis suppression by chronic steroid use and then *abrupt withdraw* |
|
|
Term
| Pt presents w/fatigue, joint pain, weight loss, abdominal pain, nausea, diarrhea, and postural hypotension. pathology? |
|
Definition
| acute adrenal insufficiency |
|
|
Term
| What are 3 ways acute adrenal insufficiency can be prevented? |
|
Definition
| 1. alternate day therapy. 2. slow taper over weeks or mos- ma take over a year for hpa axis to recover function. 3. if on chronic tx, supplement steroid doses in times of stress (sx, infection, etc) |
|
|
Term
| What is the purpose of teh ACTH stimulation test? |
|
Definition
| *to determine if hpa axis is suppressed* |
|
|
Term
| How might you determine if hpa axis is suppressed? |
|
Definition
|
|
Term
| How is an ACTH test performed? |
|
Definition
| high (250 mcg) or low (1 mcg) dose of ACTH (cosyntropin) given IM or IV. Measure serum cortisol levels at 30 and 60 min. Abnormal test if cortisol < 15 mcg/dL |
|
|
Term
| Why might a dexamethasone suppression test be performed? |
|
Definition
| *to dx cushing's syndrome* |
|
|
Term
| How might you diagnose cushing's syndrome? |
|
Definition
| dexamethasone suppression test |
|
|
Term
| How is a dexamethasone suppression test performed? |
|
Definition
| dexamethasone 1 mg give po at 11 pm and serum cortisol level ms'd at 8 am the next day. abnormal test if cortisol level elevated above 5 mcg/dL |
|
|
Term
| What class does spironolactone (aldactone) belong to? What is its primary effect? |
|
Definition
| aldosterone antagonist. K+ sparing diuretic |
|
|
Term
| What is a K+ sparing diuretic that is an aldosterone antagonist? |
|
Definition
| spironolactone (aldactone) |
|
|
Term
| What are 3 corticosteroid antagonists? |
|
Definition
| aldosterone antagonists, corticosteroid antagonists, corticosteroid synthesis inhibitors |
|
|
Term
| The following belong to what class of corticoid steroid drugs: aldosterone antagonists, corticosteroid antagonists, corticosteroid synthesis inhibitors? |
|
Definition
| corticosteroid antagonists |
|
|
Term
| What level of doses are needed for cortisol and androgen synthesis when using ketoconozole? |
|
Definition
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