Adrenal Pharm

Front 1

Characteristics of glucocorticoid receptors and how it upregulates gene expression

Back 1

nuclear receptor
receptors are in complexes with heat shock proteins (Hsp90)
free glucocorticoid hormone binds complex in the cytosol and allow conformational change to dissociate heat shock protein
ligand-bound receptor complex is actively transported into the nucleus
this homodimer (two receptor-ligand complex) binds to glucocorticoid receptor elements in the promoter region of genes

Front 2

why can prednisone be administered to pregnant women without fetal side effects

Back 2

because the fetal liver is non-functional and does not activate prednisone

Front 3

Anti-inflammation and immunosuppressive effects of glucocoticoids

Back 3

decreases circulating lymphocytes, monocytes, eosinophils, and basophils, they move from vascular bed to lymphoid tissue
increase circulating neutrophils
inhibit the function of tissue macrophages
reduce prostaglandins, leukotrienes, and COX-2
vasoconstriction by suppressing mast cell degranulation
decrease capillary permeability by reducing histamine release

Front 4

inhibits phospholipase A2

Back 4

glucocorticoids

Front 5

3 corticosteroids with no topical activity

Back 5

cortisone
prednisone
fludrocortisone
*oral only

Front 6

4 corticosteroids no with salt-retaining ability

Back 6

methyprednisolone - short-acting
triamcinolone - intermediate-acting
betamethasone - long-acting
dexamethasone - long-acting

Front 7

what should always be given along with synthetic glucocorticoids without salt-retaining activity

Back 7

fludrocortisone

Front 8

corticosteroids with most salt-retaining activity

Back 8

fludrocortisone

Front 9

what should be given to a pregnant women with high risk for congenital adrenal hyperplasia

Back 9

dexamethasone to suppress the release of fetal ACTH
Also fludrocortisone to maintain normal blood pressure

Front 10

what does an overnight dexamethasone test screen for

Back 10

patients with suppression of plasma cortisol to < 1.8 ug/dL strongly suggests the patient does NOT have Cushing's syndrome

Front 11

what is done after a patient tests positive during the overnight dexamethasone suppression test

Back 11

formal dexamethasone test to distinguish between pseudo-cushing's syndrome and actual cushing's syndrome

Front 12

differentiate the results of the formal dexamethasone suppression test

Back 12

suppression of cortisol - pseudo-cushing's syndrome (anxiety)
no suppression - cushing's syndrome

Front 13

what is the high-dose dexamethasone test used to distinguish

Back 13

whether the cushing's syndrome is pituitary-dependent or ectopic production of ACTH

Front 14

differentiate the results of the high-dose dexamethasone test

Back 14

suppression of cortisol - pituitary-dependent cushing's syndrome
no suppression - ectopic production of ACTH

Front 15

what is used to diagnose primary adrenal insufficiency, diminished response of cortisol to stimulation by this drug

Back 15

cosyntropin (synthetic ACTH)

Front 16

synthetic ACTH

Back 16

cosyntropin

Front 17

what regulates lung maturation

Back 17

cortisol

Front 18

what is given to reduce the incidence of respiratory distress syndrome in infants delivered prematurely

Back 18

IM betmethasone

Front 19

3 mechanism of action for corticosteroid inhaler used in asthma

Back 19

1. anti-inflammation
2. potentiation of B-agonist effects
3. vasoconstriction

Front 20

what happens to the adrenal cortex during glucocorticoid therapy

Back 20

atrophy due to suppression of ACTH release

Front 21

what can abrupt cessation of glucocorticoid therapy result in

Back 21

acute adrenal insufficiency

Front 22

common adverse effects of corticosteroids

Back 22

osteoporosis
infection
hypertension
edema
peptic ulcers
glaucoma
hypokalmia

Front 23

what two occasions caused increased amounts of deoxycorticosterone (DOC)

Back 23

adrenocortical carcinoma
17B-hydroxylase deficiency

Front 24

synthetic mineralcorticoid used to treat adrenocortical insufficiency

Back 24

fludrocortisone

Front 25

blocks the conversion of cholesterol to pregnenolone and causes reduction in synthesis of all hormonally active steroids

Back 25

aminoglutethimide

Front 26

two indications for aminoglutethimide

Back 26

1. breast cancer to reduce estrogen
2. malignancy of adrenal cortex to reduce secretion of steroids

Front 27

associated with increases the clearance of dexamethasone and reducing it's half-life

Back 27

aminoglutethimide

Front 28

potent and nonselective inhibitor of adrenal and gonodal steroid synthesis

Back 28

ketoconazole

Front 29

used in the treatment of cushing's syndrome

Back 29

ketoconazole

Front 30

potent glucocorticoid antagonist and an antiprogestin

Back 30

mifepristone (RU 486)

Front 31

mechanism of axn of mifepristone

Back 31

forms a complex with glucocorticoid receptor

Front 32

2 indications for mifepristone

Back 32

1. treats inoperable patients with ectopic ACTH secretion
2. adrenal carcinoma who have failed to respond to other treatments

Front 33

inhibits aldosterone and testosterone synthesis

Back 33

spironolactone

Front 34

indicated for the treatment of primary aldosteronism

Back 34

spironolactone

Front 35

indicated for the treatment of hirsuitism in women

Back 35

spironolactone

Front 36

mechanism of axn of spironolactone

Back 36

competes with the mineralcorticoid receptor and possibly interferes with androgen receptor

Front 37

adverse effects of spironolactone

Back 37

hyperkalemia
gynecomastia

Front 38

mineralcorticoid receptor antagonist that only binds to that

Back 38

eplerenone

Front 39

long-acting glucocorticoids

Back 39

betamethasone
dexamethasone

Front 40

inhibits 11B-hydroxylase activity

Back 40

metyrapone

Front 41

used to treat cushing's syndrome in pregnant women

Back 41

Metyrapone

Front 42

metryapone adrenal insufficiency test

Back 42

1. Increased 11-deoxycortisosterone (DOC) along with increased ACTH is normal result
2. Reduced DOC with increased ACT suggests primary adrenal insufficiency
3. No increase in DOC along with no increase in ACTH suggests hypothalamic-pituitary malfunction

Front 43

treatment of Addison's disease

Back 43

hydrocortisone + fludrocortisone

Front 44

treatment of Cushing's syndrome

Back 44

ketoconazole + hydrocortisone

Front 45

treatment of congential adrenal hyperplasia

Back 45

dexamethasone;
then hydrocortisone + fludrocortisone

Front 46

associated with treatment of breast cancer

Back 46

aminoglutethimide

Front 47

used in the treatment of asthma

Back 47

beclomethasone

Front 48

inhibits the cyptochome P450 enzymes necessary for the synthesis of all steroids

Back 48

ketoconazole

Front 49

antagonist of glucocorticoid receptor by forming a complex with glucocorticoid receptor; also an anti-progestin

Back 49

mifepristone (RU-486)

Front 50

indicated uses for mifepristone

Back 50

medical abortion
very rarely cushing's syndrome

Front 51

steroid synthesis antagonist associated with hepatic dysfunction as an adverse effect

Back 51

ketoconazole