Term
| 17a-hydroxylase is needed for... |
|
Definition
| switching from mineralocorticoid pathway to glucocorticoid and androgen/estrogen pathways (pregnenolone ad progresterone get |
|
|
Term
| Which enzyme is needed to switch from the mineralocorticoid pathway over to the glucocorticoid and androgen/estrogen pathways? |
|
Definition
|
|
Term
| 3b-dehydrogenase is needed for which pathways? |
|
Definition
|
|
Term
| 21b-hydroxylase is needed for which pathways? |
|
Definition
| mineralocorticoid and glucocorticoid |
|
|
Term
| Which enzyme is needed for mineralo- and glucocorticoids, but not androgens/estrogen? |
|
Definition
| 21b-hydroxylase and 11b-hydroxylase |
|
|
Term
| 11b-hydroxylase is needed for which pathway(s)? |
|
Definition
| mineralo- and glucocorticoids |
|
|
Term
| ACTH is involved with the conversion of... |
|
Definition
| cholesterol to pregnenolone |
|
|
Term
| the glucocorticoid pathway is similar to the mineralocorticoid pathway. What is the major difference? |
|
Definition
| glucocorticoids get 17a-hydroxylated (which messes it up so it's not a KETONE like aldosterONE) |
|
|
Term
| Aldosterone is formed directly from... |
|
Definition
|
|
Term
| 17,20-lyase is important for... |
|
Definition
| switching from glucocorticoids to androgens/estrogens |
|
|
Term
| if you cut out 21b-hydroxylase and/or 11b-hydroxylase, you can still make... |
|
Definition
|
|
Term
| When are ACTH and glucocorticoid levels the highest? Lowest? |
|
Definition
| in the morning before breakfast, during sleep |
|
|
Term
| The acetonide-substituted cortisol derivatives, like _________, have increased ______ _____ and are useful in ________ |
|
Definition
| triamcinolone, surface activity, dermatology |
|
|
Term
| In betamethasome the methyl group at C16 is ___ and projects ___, whereas in dexamethasone it is ___ |
|
Definition
|
|
Term
| Name the glucocorticoid category for these: hydrocortisone, cortisone, prednisone, prednisolone, methylprednisone, meprednisone |
|
Definition
|
|
Term
| name the short to medium acting glucocorticoids |
|
Definition
| hydrocortisone, cortisone, prednisone, prednisolone, methylprednisone, meprednisone |
|
|
Term
| Name the intermediate-acting glucocorticoids |
|
Definition
| triamcinoline, paramethasone, fluprednisone |
|
|
Term
| triamcinolone, paramethasone and fluprednisone are _____-acting glucocorticoids |
|
Definition
|
|
Term
| name the long-acting glucocorticoids |
|
Definition
| betamethasone, dexamethasone |
|
|
Term
| name the mineralocorticoid drugs |
|
Definition
| fludrocortisone, DOC acetate |
|
|
Term
| fludrocortisone and DOC acetate are... |
|
Definition
|
|
Term
| betamethasone and dexamethasone are _____-acting glucocorticoids |
|
Definition
|
|
Term
| which glucocorticoids are available for topical use? |
|
Definition
| hydrocortisone, triamcinoline, betamethasone, dexamethasone |
|
|
Term
| hydrocortisone, triamcinoline, betamethasone, dexamethasone are all available in which form? |
|
Definition
|
|
Term
| which glucocorticoids are only available in oral form? |
|
Definition
| cortisone, prednisone, fluprednisone |
|
|
Term
| cortisone, prednisone and fluprednisone are ONLY available to take ____ |
|
Definition
|
|
Term
| which glucocorticoids are NOT available in oral form? |
|
Definition
| none - they are ALL available orally |
|
|
Term
| What are the available forms of DOC acetate? |
|
Definition
|
|
Term
| which mineralocorticoid is only available for oral use? |
|
Definition
|
|
Term
| fludrocortisone is primarily a _____corticoid but has _____corticoid action |
|
Definition
|
|
Term
| Which are the most potent glucocorticoids? |
|
Definition
| dexamethasone, betamethasone, then fluprednisolone and paramethasone |
|
|
Term
| which drug has the most salt-retaining activity? |
|
Definition
|
|
Term
| to suppress ACTH production for diagnostic purposes, it is advantageous to use... |
|
Definition
| potent substance like dexamethasone |
|
|
Term
| to distinguish a patient with Cushing's from those with steroid-producing tumors or ectopic ACTH, you give a large dose of _______, then assay the urine, which is called _____'s test. In Cushing's, the hormones will be reduced by about ___%. |
|
Definition
| dexamethasone, Liddle's, 50% |
|
|
Term
| IM ______ is given to pregnant women who are going to delivery prematurely to speed lung development in the fetus |
|
Definition
|
|
Term
| Why is betamethasone used for fetal lung maturation? |
|
Definition
| maternal protein binding and placental metabolism is less than that of cortisol |
|
|
Term
| When long term glucocorticoid use is anticipated, you should get which tests? You should consider the presence of which other physiological conditions? |
|
Definition
| CXR and PPD, diabetes, PUD, osteoporosis, psychological disturbance |
|
|
Term
| Which adverse effects can sometimes be seen after only a few days of tx with glucocorticoids? |
|
Definition
| insomnia, behavioral changes (hypomania), acute peptic ulcers |
|
|
Term
| What is a rare but serious adverse effect of high dose glucocorticoids? |
|
Definition
|
|
Term
| name the features of iatrogenic Cushing's syndrome |
|
Definition
| moon facies, fat redistribution, fine hair on face, punctate acne, insomnia, increased appetite, increased need for insulin, weight gain, visceral fat deposition, myopathy and muscle wasting, thinning of skin, striae, bruising, hyperglycemia, osteoporosis, diabetes, aseptic necrosis of the hip, impaired wound healing |
|
|
Term
| Patients on long term corticosteroids should be on which kind of diet? |
|
Definition
| high protein and potassium-enriched |
|
|
Term
| what do glucocorticoids do to the concentrations of neutrophils, lymphocytes, monocytes, eosinophils and basophils in the blood? |
|
Definition
| increase neutrophils, decrease everything else |
|
|
Term
| how do glucocorticoids increase the concentration of neutrophils in the blood? |
|
Definition
| increased influx from bone marrow, decreased migration from the blood vessels, leading to a reduction in the number of cells at the site of inflammation |
|
|
Term
| glucocorticoid effect on ______s is particularly marked, and reduces their ability to produce ___, ____, ______, and _____. |
|
Definition
| macrophages, TNF-a, IL-1, metalloproteinases, plasminogen activator |
|
|
Term
| glucocorticoids cause both macs and lymphos to produce less.. |
|
Definition
| IL-12 and IFN-y, inducers of Th1 cell activity |
|
|
Term
| glucocorticoids reduce activation of phospholipase A2, which results in decreased amounts of... |
|
Definition
| prostaglandin, leukotriene, PAF |
|
|
Term
| glucocorticoids reduce expression of COX2, which produces... |
|
Definition
|
|
Term
| what do glucocorticoids accomplish when you apply them to the skin? |
|
Definition
| vasoconstriction by suppressing mast cell degranulation, decrease cap permeability by reducing histamine released from basophils and mast cells |
|
|
Term
| antibody production can only be reduced by ____ doses of glucocorticoids |
|
Definition
|
|
Term
| adrenal insuff causes what effects on brain activity? |
|
Definition
| slowing alpha rhythm, depression |
|
|
Term
| increased amts of glucocorticoids can cause what behavioral disturbances? |
|
Definition
| insomnia, euphoria, then depression. |
|
|
Term
| large doses of glucocorticoids can have what affect on ICP? |
|
Definition
| increased, pseudotumor cerebri |
|
|
Term
| Glucocorticoids can antagonize the action of ______ on calcium abs |
|
Definition
|
|
Term
| Describe the effects of cortisol deficiency on renal function |
|
Definition
| impaired renal function (glomerular filtration), augmented vasopressin secretion, diminished ability to excrete a water load |
|
|
Term
| describe the features of adrenocortical insufficiency |
|
Definition
| fatigue, weakness, weight loss, hypotension, hyperpigmentation, inability to maintain blood glucose during fasting |
|
|
Term
| Name the disorder: hypertension, weakness, tetany, hypokalemia, alkalosis, hypernatremia |
|
Definition
|
|
Term
| pts receiving glucocorticoids should be monitored for... |
|
Definition
| hyperglycemia, glycosuria, sodium retention with edema or hypertension, hypokalemia, peptic ulcer, osteoporosis and hidden infections |
|
|
Term
| beclomethasone, budesonide, flunisolide and mometasone are sometimes used for... |
|
Definition
|
|
Term
| mineralocorticoids act by binding to which recepts? |
|
Definition
| principal cells of DCT and collecting tubules |
|
|
Term
| the major cellular effect of activation of the aldosterone receptor is... |
|
Definition
| ^ expression of Na/K-ATPase and ENaC |
|
|
Term
| which androgen is secreted in large amounts by the adrenal cortex? |
|
Definition
|
|
Term
| _____ blocks the conversion of cholesterol to pregnenolone, reducing the synthesis of all hormonally active steroids |
|
Definition
|
|
Term
| What does aminoglutethimide do? |
|
Definition
| block cholesterol -> pregnenolone, decrease all hormonally active steroids |
|
|
Term
| what does ketoconazole do? |
|
Definition
| blocks the p450 enzymes needed for adrenal and gonadal steroid synthesis |
|
|
Term
| which drug inhibits the P450 enzymes involved with steroid synthesis? |
|
Definition
|
|
Term
|
Definition
| inhibits 11-hydroxylation, interfering with cortisol and corticosterone synthesis |
|
|
Term
| with higher doses of aminoglutethimide, ____ and ____ were common side effects |
|
Definition
|
|
Term
| which drug interferes with 11-hydroxylation and therefore cortisol and corticosterone synthesis? |
|
Definition
|
|
Term
| metyrapone may produce transient... |
|
Definition
| dizziness and GI disturbance |
|
|
Term
| which drug may produce transient dizziness and GI disturbance? |
|
Definition
|
|
Term
| the toxicity of metyrapone is much less than that off... |
|
Definition
|
|
Term
| ____ is the only adrenal-inhibiting medication that can be administered to pregnant women with Cushing's |
|
Definition
|
|
Term
| what are the major side effects of metryapone? |
|
Definition
| salt and water retention and hirsutism from diversion of 11-deoxycortisol precursor to DOC and androgens |
|
|
Term
| _____ is a 3B-17 hydroxysteroid dehydrogenase inhibitor that interferes with synthesis of adrenal and gonadal hormones, and is comparable to aminoglutethimide. Adverse effects are mostly ___. |
|
Definition
| trilostane, gastrointestinal |
|
|
Term
|
Definition
| inhibitor of 3b-dehydrogenase, interferes with all the hormones |
|
|
Term
|
Definition
| blocks 17a-hydroxylase and 17,20 lyase, reduces synthesis of cortisol and gonadal steroids |
|
|
Term
| Which drug blocks 17a-hydroxylase and 17,20-lyase, reducing synthesis of glucocorticoids and gonadal steroids? |
|
Definition
|
|
Term
|
Definition
| RU-486, glucocorticoid recep antag, also strong antiprogestin activity |
|
|
Term
| which drug is a glucocorticoid receptor antagonist? |
|
Definition
| mifepristone (RU-486), also antiprogestin |
|
|
Term
| Which drug has nonselective cytotoxic action on adrenal cortex in dogs and less in humans, was used for adrenal carcinoma, now withdrawn due to side effects |
|
Definition
|
|
Term
|
Definition
| nonselective-cytotoxic to adrenals, withdrawn due to side effects |
|
|
Term
| What is spironolactone? What is it used for? |
|
Definition
| aldosterone recep antag, treatment of primary aldosteronism, also an androgen antagonist and is sometimes used in treatment of hirsutism in women |
|
|
Term
| spironolactone as a diuretic has benefits in _____ ____ |
|
Definition
|
|
Term
| What are the adverse effects of spironolactone? |
|
Definition
| hyperkalemia, cardiac arrhythmia, menstrual abnormalities, gynecomastia, sedation, HA, GI disturbance, skin rash |
|
|
Term
| Eplerenone is what kind of drug? used for what? Somewhat more selective than which other drug? Tox? |
|
Definition
| aldosterone recept antag, for hypertension, more selective than spironolactone with no androgen effects, hyperkalemia - usually mild |
|
|
Term
| which drug is a more selective aldosterone receptor antagonist, used in hypertension, and can cause mild hyperkalemia? |
|
Definition
|
|
Term
| what is drospirenone? It antagonizes the effects of what? |
|
Definition
| a progestin in oral contraceptives, aldosterone |
|
|
Term
| which drug is a progestin in oral contraceptives and antagonizes the effects of aldosterone? |
|
Definition
|
|
Term
| Which zone of the adrenal cortex makes glucocorticoids? mineralocorticoids? androgens? |
|
Definition
| fasciculata, glomerulosa, reticularis |
|
|
Term
| What are the really short acting GCs? |
|
Definition
| hydrocortisone, cortisone |
|
|
Term
| Period of time of therapy after which GC therapy will need to be tapered |
|
Definition
|
|
Term
| biosynthesis inhibitor used for Cushing's syndrome (increased corticosteroid) and sometimes for adrenal function test? |
|
Definition
|
|
