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Advanced Pharmacology
Pharmacology of Adrenal Corticosteroids
29
Medical
11/28/2010

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Cards

Term
What is the medulla of the adrenal gland responsible for producing?
Definition
*Catecholamines
Term
What is the cortex of the adrenal gland responsible for producing?
Definition
*Glucocorticoids, Mineralcorticoids, and androgens
Term
What is the hormone responsible for the regulation of extracellular fluid volume?
Definition
*Aldosterone (Mineralcorticoids)
Term
How does aldosterone work?
Definition

*Works in the distal renal tubules by controlling sodium resorption and excretion.

*Increases serum Na and decreases serum K

Term
How is aldosterone secretion stimulated?
Definition

*Angiotension (AT II) strongest stimulus (most important predictor of volume status)
*ACTH

*Hypotension

*CHF

*Surgery

*Serum Potassium levels

 

Term
What is cortisol and what are its main functions?
Definition

*(Hydrocortisone) Glucocorticoid

*Functions: Carbohydrate metabolism, protein metabolism, fat metabolism, stress response, anti-inflammatory response.

Term
What are the anesthetic considerations for patients with aldosteronism?
Definition

*Fluid and electrolyte correction (K+, Ca++)

*Aldactone (K+ sparing diuretic)- aldosterone antagonist

Term
How much cortisol does the normal adult secrete?
Definition
*20mg of cortisol
Term
What is a normal oral dose of hydrocortisone and prednisone?
Definition

*20-30mg daily Hydrocortisone

*5mg/am, 2.5mg/pm Prednisone

Term
Pharmacologic doses are used as ____________ that is just enough to provide higher than normal physiologic hormone levels to get a desired effect.
Definition
*Supra-physiologic
Term
Patients with acute adrenal insufficiency will diminish the body's ability to appropriately respond to a stressful situation such as.....
Definition

*Surgery

*Trauma

*Infection 

Term
If a patient cannot properly respond to physiologic demands it may lead to devastating physiologic consequences to a patient such as: 
Definition

*Circulatory collapse

*Hypoglycemia

*Hypotension

 

Term
What is considered "too much" steroid use and thus elicits the need for a replacement stress dose?
Definition
*The patient should be considered unable to adequately respond to a stressor if they have received 5mg of prednisone for more than 2 weeks in the past 12 months.
Term
Most exogenous steroids possess both _____ and ________ properties.  Agents differ mainly by their _______ and their ____________.
Definition

*mineral 

*glucocorticoid

*glucocorticoid

*Potency

Term
Oral Hydrocortisone is used primarily for ______________ therapy.  Usually a daily dose of ________mg is used.
Definition

*Physiologic replacement

*20-30mg

Term
In complete absence of adrenal secretion the synthetic mineralcorticoid ___________ may be added.
Definition
*Fludrocortisone
Term
What are the high dose and low dose recommended regimes for patients receiving steriod replacement for surgery?
Definition

*Low dose:

-25mg of hydrocortisone on induction

-100mg hydrocortisone preop, 100mg intraop, 100mg post op evening.

Term
What steroids are avoided in hepatic failure?
Definition
*Prednisone and cortisone
Term
What is a good treatment for Hyperaldosteronism?
Definition
*Can use aldactone (a K sparing diuretic) an aldosterone antagonist
Term
What are clinical manifestations of an aldosterone deficiency?
Definition

*Hyperkalemic

*Acidotic

*Hypotensive

Term
What is used for the treatment of an Aldosterone deficiency?
Definition
*Fludrocortisones
Term
How is the synthesis and release of glucocorticoids controlled?
Definition
*By the hormones released from the hypothalamus and pituitary gland (Pituitary Adrenocortico Axis)
Term
When is cortisol secreted?
Definition
*When cortisol levels drop below a set point, the hypothalamus releases CRH which stimulates ACTH release from the pituitary which stimulates the adrenals to release cortisol.
Term
What happens when cortisol levels rise to regulate further release?
Definition

*CRH and ACTH secretion is inhibited 

*Negative feedback system

Term
Cortisol is responsible for ________ Metabolism.
Definition
*Carbohydrate
Term
Aldosterone is a large factor in __________ regulation.
Definition
*Water
Term
What hormone that is released from the anterior pituitary regulates glucose?
Definition
*ACTH
Term
How are glucocorticoids metabolized?
Definition
*The liver
Term
What is the most potent regulator of ACTH?
Definition
*Cortisol