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Glucocorticosteroids
st
57
Pharmacology
Graduate
12/07/2012

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Cards

Term
"___ function as regulators of the endocrine system. "
Definition
Hypothalamus and Pituitary gland.
Term
Name five axis of hypothalamus and pituitary gland function
Definition
- Mineralocorticoids (aldosterone),
- Glucocorticoids (cortisol),
- Adrenal androgens, estrogens, pogestins
(Dehydroepiandrosteone, estrone, estradiol, estriol)
- Antidiuretic hormine (ADH)
- Oxytocin"
Term
"Corticotrophic Releasing Hormone (CRH)
"
Definition
"- Hypothlamus
- secretion stimulated by parasympathetic pathways, circadian rhythms, stess, infection, hypoglycemia"
Term
Adrenocoticotropic Hormone (ACTH)
Definition
"- Anterior pituitary
- stimulates the adrenal cortex
- synthesis of cotisol and other glucocorticoids"
Term
"Cortisol (hydrocortisone)
physiologic vs pharmacologic effects"
Definition
"- Physiologic functions: occur at low concentrations, regulation of immune status, minimal storage, synthesized as needed

- Pharmacologic effects: occur at high concentrations, exogenous (drugs): use for allergic reactions, inflammatory diseases, autoimmune diseases
Term
Corticol    "Designated biological effects,
Acts on the hypothalamus and pituitary, suppressing further release of CRH and ACTH - feedback inhibition. "
In the ___, both ACTH and corticol stimulate conversion of ____ to ___.
Definition
"Adrenal Medualla, NE to Epinephrine
- Cortisol further inhibits tissue uptake of epinephrine, increasing plasma levels of available epinephrine
 (This is why we give a pt IV steroids when they suffer cardiogenic or septicemic shock) "
Corticol effects on carbohydrate   
Term

Glucocorticoids effects of Protein Metabolism      
Definition
- stimulate protein catabolism (breakdown): increase gluconeogenesis; chronic, high concentrations of glucocorticoids cause thinning of the skin, muscle wasting and negative nitrogen balance.
Term
Glucocorticoids effects on Fat Metabolism
Definition
"- Stimulate Lipolysis (fat breakdown) while inhibiting the glucose uptake by adipose tissue
- chronic, high concentrations cause fat redistribution --> Cushing's syndrome:
- potbelly, ""moon face"" and buffalo hump"" on the back"
Term
Glucocorticoids effects on Cardiovascular System
Definition
"- Functional integrity of the vascular system
- At low concentrations: capillary permeability increased, decreased ability of vessels to constrict, BP decreased
- Blood cells: increased RBC counts, increased levels of hemoglobin, PMN
- Eosinophils, basophils and monocytes are decreased (thus, increased infection)"
Term
Glucocorticoids effects on Skeletal Muscle
Definition
"- When glucocorticoid level is insufficient, muscle perfusion is decreased
- Muscle atrophy"
Term
Glucocorticoids effects on CNS
Definition
- Glucocorticoid insufficiency is associated with depression, lethargy and irritability. Rare cases of Psychosis.
- Excess -->  generalized excitation and euphoria"
Term
Glucocorticoids effects on Stress
Definition
"Physiological stress: anxiety, exercise, trauma, infections, surgery
- Glucocorticoid secretion increased (adrenal cortex)
- Epinephrine secretion increased (adrenal medulla)
- Both glucocortiocoid & epinephrine together maintain BP and blood glucose content. "
 
Term
___ and ___ together maintain BP and blood glucose content 
Definition
Glucocorticoids and Epinephrine
Term
What happens if glucocorticoids levels are insufficient?
Definition
"-Response to stress: negative feedback, inability to release more cortisol.
- mild stress: hypotension and hypoglycemia
- extreme stress (trauma, surgery, severe infection): circulatory collapse and death. "
Term
What do you give a patient if you patient in having severe stress stress occurs or is expected?
Definition
As prevention, give pt glucocorticoid
Term

"glucocorticoids
Mechanisms of Action"
Definition
"-Corticosteroid is bound to corticosteroid-binding protein (CBP) as steroid-CBP complex
-Reaches the target cells, uncouples from steroid-CBP complex --> free steroid enters cells
-In the nucleus, the dug then binds to DNA resulting in either:
(1) Repression (prevent transcription) or (2) Induction (initiate transcription) of particular genes
- This initiates signaling pathways resulting in synthesis of lipocortin-1"
Lipocortin-1    -inhibits phospholipase A2, which inhibits cyclooxygenase and 5-lipoxygenase pathways
Term
"Glucocorticoids
Anti-inflammatory Effects"
Definition
 "-Inhibit the production of Arachidonic acid metabolites (Prostaglandins PGG, PGE, PGI, PGF2)
-Multiple actions on leukocytes:
(1) suppress the activation of T lymphocytes,
(2) suppress the production of cytokines by activated T cells,
(3) prevent the release of lysosomal enzymes (catabolic enzymes),
(4) cause vasoconstriction and decrease capillary permeability"
Term
How does cytokines play a major role in inflammation?
Definition
    By recruiting and activating eosinophils and by stimulating antibody production by B cells.
Term
Glucocorticoids ___(increase/decrease)___ bone _____ and antagonize the effect of vitamin ___. What diseases can it contribute to?    
Definition
"Increase bone catabolism and antagonize the effect of Vitamin D on calicum absorption.
- Contribute to the development of osteoporosis"
Term
Glucocorticoids ____ the gastroprotective effect of prostaglandins.   
 
Definition
"Inhibit
- it may stimulate the gastric acid and pepsin production --> exacerbate peptic ulcers"
Term
Glucocorticoids:
(1) Suppression of the response to infection or injury"
Definition
"-An infection may be serious and treated with antimicrobial agents along with an increase in the dose of steroid, which may suppress the response
- Impaired wound healing
"-An infection may be serious and treated with antimicrobial agents along with an increase in the dose of steroid, which may suppress the response
Term
Impaired wound healing " Glucocorticoids use in concurrent with high doses of ____ may be a cause for peptic ulcerations
Definition
aspirin
Term
"Glucocorticoids
(2) Suppression of a patient's ability to synthesize corticosteroids"  

Definition
    "-sudden withdrawal after prolonged therapy may result in acute adrenal insufficiency
-phased withdrawal/ tapeing of the thearpy should be done
-Recovery of full adrenal function usually takes about 2 months, though it can take 18 months or more
-Chronic uses may lead to adrenal atrophy"

Term
"Glucocorticoids
(3) Metabolic effects"
Definition
"-Supra-physiological doses:
-water and electrolyte retention
-hypokalemia
-rounded, puffy (moon faces), fat accumulation in the supraclavicular and dorsocervical areas - Buffalo hump
-increased hair growth (hirsutism); weight gain; muscle wasting and weakness"
Term
How does glucocorticoids influence bone metabolism?
Definition
"-regulation of calcium & phosphate metabolism
- collagen synthesis by osteoblasts and collagen degradation by collagenase"
Term
"Glucocoticoids:
Dental adverse effects"
Definition
"-Oral candidiasis -systemic and inhalation
-Hypercoagulability of blood
-osteonecrotic jaw (ONJ)"
Term
"Hydocortisone,
Cortisone"
Definition
"-Corticosteriods, short-acting
-8 to 12 hours; have equal glucocorticoid and mineralocorticoid effects
-preferred for replacement therapy -Adrenal insufficiency
-anti-inflammatory, but more potent agents are preferred agents for severe inflammatory and autoimmune diseases"
Term
Pednisone, Prednisolone, Methylprednisone, Triamcinolone 
Definition
  "Intermediate acting corticosteroids
- 12-36 hours; commonly used for systemic treatment
-management of inflammation, allergy and autoimmune disorders"
Term
Betamethasone
Definition
"Long-acting corticosteriods
- Frequently used as topical treatment for skin disorders"
Term
Dexamethasone
Definition
"long-acting corticosteriods
- treatment of shock as well as neoplastic, infectious and inflammatory conditions that require the use of potent and long acting agents"
Term
Beclomethasone
Definition
"long-acting corticosteroids, inhalator
- nasal or lung for allergic rhinitis and asthma"
Term
Adrenal Suppression
Definition
the physiologic inability of the adrenal glands to produce maximal cortisol levels (equivalent to 60 mg Prednisone/day) during maximal stress
Term
Which type of patient will be at risk for adrenal suppression?
Definition
"(1) Patients who have received 20 mg prednisone/day or equivalent for 7-10 days in the past year.

(2) patients receiving typical maintenance dose of steroids daily (10-20 mg prednisone/day o the equivalent)"
   
Term
Absolute contraindications for Corticosteroids 
Definition
  -Cataract, glaucoma, tuberculosis, ocular herpes simplex, infections (fungal, viral parasitic), peptic ulcer, osteoporosis, psychosis

Term
Relative contraindications for corticosteoids 
Definition
CHF (increase fluid load); diabetes mellitus (anti-insulin effect); Digitalis therapy (hypokalemia, percipitate digitalis cardiotoxicity), hypertension

Term
Clinical Uses of glucocorticoids
Definition
(1) Replacement therapy (Addison's disease, secondary adrenal corticol insufficiency, congenital adrenal hyperplasia). (2) Anti-allgeric and anti0inflammatoy therapies. (3) Cancer treatment (immunosuppression). (4) hypotension. (5) diagnostic use
Term
Addison's Disease  
Definition
"-Chronic adrenal insufficiency
-Rare, chronic endocrine disorder
-Diagnosed through diagnostic imaging
-Symptoms: Fatigue, muscle weakness, PUO, headache, orthostatic hypotension
-Hyperpigmentation (Buccal mucosa)
-Type 1 Diabetes, Hashimoto's thyroiditis"

Term
Topical glucocorticoids    "Formulations:
Definition
(1) Adhesive-based vehicles: localized for prolonged periods, but may peel mucosal lining. (2) Ointments or propylene glycol creams: better penetration - hydrates the stratum corneum (3) Cream/ lotions: better patient compliance - cosmetic reasons. (4) gel: less satisfactory because of instability. (5) spray: expensive with no increased efficacy."
 
Term
Topical Glucocorticoids - Dental Clinical Applications   
Definition
"1. Oral lesions: aphthous stomatitis, vesiculo-bullous diseases, burning mouth/tongue, stomatitis {drug induced} and cancer (all the ""-itis"" that occurs orally)
2. Magic mouth wash cocktail: local anesthetics, antihistamines, antimicrobials
3. Ulcerations or irritations: oral lichen planus, lupus erythematosus
4. Systemic absorption does occur - prolonged and/or overuse have systemic adverse effects"
Term
Aminoglutethimide   
Definition
"Corticosteroid synthesis inhibitors
-inhibit a rate limiting step of the biosynthetic pathway.
-Treatment of breast cancer and malignant Adrenocortical tumors.Combined with Metyaprone to treat Cushing's syndrome."

Term
Metyraprone
Definition
  "Corticosteroid synthesis inhibitors
-Inhibit synthesis of glucocorticoids by inhibiting the 11 beta-hydroxylase enzyme.
-Treatment of Cushing's syndrome who are refractory to other treatments"
Term
Ketoconazole  
Definition
"Corticosteriod Synthesis Inhibitors
-Azole antifungal
-Inhibits P450 enzymes involved in the biosynthesis of glucocorticoids
-Treatment of Cushing's syndrome"
  
Term

Thyroid Hormones
Definition
    "Thyroid Gland
(1) Follicular thryoid cells secrete Thyroxine (T4) and Triiodothyronine (T3) -Regulate energy metabolism and growth, from oxygen consumption to cardiac contractility
(2) Parafollicular C cells secretes Calcitonin - regulator of bone mineral homeostasis"
Term
T4   
Definition
Thyroxine, T4 is eventually converted to T3

Term
T3   
Definition
"Triiodothyronine: Active component
-circulates thoughout the body. Influences: growth, development and maturation of various tissues; metabolic effects through control of DNA transcription and protein synthesis; Gluconeogenesis; increases utilization and mobilizations of glycogen stores; increases basal metabolic rate"

Term
Hyperthyroidism Diseases
Definition
Graves disease, Toxic multinodular goitre (Plummer's disease), Toxic adenoma, Hashimoto's Dieases, subacute thyroiditis
Term
Thyrotoxicosis 
Definition
  Excessive circulating thyroid hormones; excessive heat, increase sympathetic activity, increase pain sensitivity, protruding eyes, anxiety, avoid epinephrine

Term
"Hyperthyroidism:
Non pharmacological management"  
Definition
"-Adequate nutrition, hydration and rest (especially in the elderly)
-Subtotal thyroidectomy
- Patients with Grave's disease; Toxic adenoma, Toxic Multinodular Goitre"

Term
"Hyperthyroidism:
Pharmacological Management"  
Definition
-Thioamides: methimazole, popylthiouracil (PTU; Iodine (potassium iodide); radioactive iodine (131 I) - except in subacute thyroiditis and during pregnancy; Beta-blockers

Term
Thioamides    Tx of hyperthyroidism
Definition
Methimazole, Propylthiouracil (PTU)    "Thioamides:
Indicated for hyperthyroid patients except in subacute thyroiditis.
-MOA: Decrease T4 and T3 productions/synthesis. Decrease conversion of T4 to T3
-Adverse Effects: maculopapular pruritic rash +/- fever, urticaria rash, vasculitis, arthralgia, Lupus-like reaction"
Term
Potassium Iodide   
Definition
"Non-radioactive. Inhibits Iodine dependent hormone release. Decrease the size and vascularlity of the hyperplastic gland.
-Prior to surgery, given orally or IV to patients with Grave's disease.
-Adverse Effects: salivary gland swelling/tenderness"

Term
Radioactive Iodine (131 I)  
Definition
"-Oral administration, taken up by thyroid and incorporated into storage follicles
- Destruction of thyroid parenchyma"

Term
Beta-blockers  
Definition
"use for hyperthyroidism treatment.
-Adjuvant agent
-Reduce hyperthyroid symptoms - palpitations, tremor, sweating
-Do not alter circulating T4
-Non-selective beta blockers decrease circulating T3 levels"

Term
Hypothyrodism  
Definition
"-Syndrome characterized by low circulating levels of T4 and T3.
-rare cases where tissue becomes resistant to thyroid hormones.
-Have a reversible slowing down of all body function. Infants & children - growth and developmental retardation. (Mental retardation is irreversible)"
Term
Hypothyroidism Pathology
Definition

-Primary Hypothyroidism (Thyroid)

-Secondary Hypothroidism (Pituitary)

-Tertiary Hypothroidism (Hypothalamus)

-Generalised resistance to thyroid hormones (peripheral tissues)

                    -Usualy caused by a defect in the beta recepor for T3 and T4

Term

Hypothyroidism Management

Definition

-Replacement with T4 or T3 or thyroid extract products

            -Dosage should not take place more frequently than 4 to 6 weeks

-Sodium Levothyroxine

             -Synthetic T4 hormone

-Thyroid, USP

-Liothyronine

             -Synthetic T3

-Liotrix

             -Synthetic T4/T3 Combination preperation

 

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