Pharm 3 Chapter 26

Front 1

What does the cortex of the adrenal gland synthesize and secrete?

Back 1

Adrenal Androgens
Adrenocorticosteroids --> glucocorticoids and mineralocorticoids

Front 2

What are the 3 zones of the Cortex of the Adrenal Glands

Back 2

outer zona glomerulosa
middle zona fasiculoata
innera zona reticularis

Front 3

What does the Outer zona gloerulosa produce?

Back 3

mineralocorticoids --> aldosterone

Front 4

What does the middle zona fasiculoata synthesize?

Back 4

Glucocorticoids: cortisol

these are feedback inhibitors of corticotrophin and CRH secretion

Front 5

What does the inner zona reticularis secrete?

Back 5

adrenal androgens
specifically, dehydroepiandrosterone

Front 6

What does the medulla of the adrenal gland secrete?

Back 6

epinephrine

Front 7

What is the difference in the distribution of glucocorticoids and mineralocorticoids?

Back 7

glucocorticoid receptors are widely distributed in the body

Mineralocorticoid receptors are confined to excretory organs (kidneys, salivary and sweat glands)

Front 8

What is the principal human glucocorticoid?

Back 8

cortisol

Front 9

How would you describe the production of cortisol?

Back 9

diurnal
peaking in early AM
smaller peak in late afternoon

Front 10

How does cortisol promote normal metabolism?

Back 10

1. favors gluconeogenesis (increase AA uptake in the liver and kidneys.
2. Stimulates protein catabolism and lipolysis

Front 11

If you are deficient in glucocorticoid, what metabolic imbalance might you develop?

Back 11

hypoglycemia

Front 12

What are the main functions of cortisol in the body?

Back 12

1. promote normal metabolism.
2. increase resistance ito stress
3. alter blood cell levels in the plasma
4. anti-inflammatory

Front 13

When cortisol increases resistance to stress, what effects does this have on the body?

Back 13

provides the body with energy to combat stress (trauma, fright, infx, dz)

causes rise in BP to enhance vasoconstrictor action of adrenergic stimuli on small vessels

Front 14

How does cortisol affect blood cell levels in plasma?

Back 14

REDISTRIBUTES the cells below to the lymphoid tissue and causes a plasma levels to DECREASE in these cells --> leads to decreased ability to fight infx
-eosinophils
-basophils
-monocytes
-lymphyoctes

Front 15

How does cortisol affect the blood levels of Hgb, RBC, platelets, and PMNs?

Back 15

increase

Front 16

What is the most important tx property of cortisol/glucocorticoids?

Back 16

to reduce inflammatory response and suppress immunity

Front 17

What 3 ways does cortisol/glucocorticoids reduce inflammatory responses and suppress immunity?

Back 17

1. lowering and inhibitin peripheral lymphocytes and macrophages
2. inhibition of phospholipase A2
3. interference in mast cell degranulation

Front 18

How does cortisol/glucocorticoids inhibit phosholipase A2?

Back 18

blocks the release of arachidonic acid which is the precursor of prostaglandins and leukotrienes

Front 19

What is the effect of cortisol/glucocorticoids when it interferes with the mast cell degranulation?

Back 19

decreased histamine and capillary permeability

Front 20

What do glucocorticoids do that exacerbates ulcers?

Back 20

stimulates gastric acid and pepsin production

Front 21

What does Chronic therapy with glucocorticoids cause?

Back 21

server bone loss
myopathy

Front 22

Aldosterone is a glucocorticoid or mineralocorticoid

Back 22

mineralocorticoid

Front 23

How does aldosterone affect urine?

Back 23

-reabsorption of Na, HCO3, and H2O
(retained)
-decreased reabsorption of K+ and H+
(lost in urine)

Front 24

What do elevated levels of aldosterone cause and how do you treat it?

Back 24

-alkalosis and hypokalemia
-retention of Na+ and H2O --> increased blood volume and BP

Tx: Spironolactone

Front 25

semisynthetic derivatives of glucocorticoids vary in what 3 aspects?

Back 25

1. anti-inflammatory potency
2. degree of sodium retention
3. duration of action

Front 26

Primary adrenocortical insufficiency is AKA as ________ is caused by _________ and diagnosed by ____________

Back 26

Addison's Disease
adrenal cortex diysfunciton
Lack of pt to respond to corticotropin administration

Front 27

Symptoms of Addison's

Back 27

Headache
Abd pain
N/V
Low BP and dehydration --> shock
Hyperpigmentation
hypoglycemia
Hyponatremia
Hyperkalemia
Eosinophilia and lymphocytosis
Inc. ACTH if it's primary Addison's

Front 28

Tx. of Addisons/primary adrenocortical insufficiency

Back 28

Hydrocortisone (identical to natural cortisol)
Fludrocortisone (synthetic mineralocorticoid with glucocorticoid activity)

Front 29

Cause and Treatment of 2* or 3* adrenocortical insufficency

Back 29

Cause: defect in CRH production by the hypothalamus or in corticotropin production by pituitary

Tx: Hydrocortisone

Front 30

2 causes of Cushing Syndrome
Which is more common?

Back 30

1. Hypersecretion of glucocorticoids due to excessive release of coricotrophin by ant. pituitary or adrenal tumor

2. chronic high doses of glucocorticoids (more frequent cause)

Front 31

Sx of Cushing

Back 31

central obesity
purple striae
moon face
buffalo hump
easy bruising

Front 32

Signs of Cushing

Back 32

HTN
hyperglycemia
Hypokalemia
glucosuria
lymphocytopenia
increased serum cortisol
increased susceptibility to infx

Front 33

How do you dx Cushing?

Back 33

DAST - dexamethasone suppression test
-suppresses cortisol release in pituitary-dependent Cushings
- does not suppress glucocorticoid release from adrenal tumors b/c the tumor releases without consideration of the feedback loop

Front 34

Tx of Cushing and how the tx affects the body

Back 34

Glucocorticosteroids
- redness, swelling, heat, tenderness improve (decreased inflammatory sx)
- redistribution of leukocytes to otehr body compartments --> lowers BLOOD concentration

Front 35

Effects of glucocorticosteroids on the body

Back 35

1. increase in neutros
2. decrease in lymphs, baso, eos
3. inhibition of ability of leukocytes and macrophages to respond to Ag
4. decreased production of prostaglandins and leukotrienes
5. reduce amt of histamine released from basophils and mast cells

Front 36

In what situations could you use glucocorticoids??

Back 36

allergies
bronchial asthma
allergic rhinitis
drug rxn
serum rxn
transfusion rxn
lung maturation

Front 37

Beclomehtasone and triamcinolone
1. What are they used for?
2. How are they applied?
3. What benefits does this provide?

Back 37

1. Glucocorticoid
2. topically to resp tract thru inhalation
3. minimizes systemic effects and reduces/eliminates use of oral steroids

Front 38

When are glucocorticoids used for Lung Maturation?

Which one is used? Administration?

Back 38

respiratory distress in premature infants (fetal cortisol is the regulator of lung maturation)

Beclomethasone - IM to mother 48hrs and 24 hrs before delivery

Front 39

Prinicples for dosing of steroids

Back 39

- consider glucocorticoid vs mineralocorticoid activity
- large doses over 2 wks suppress the hypo-pit-adrenal (HPA) axis

**alternate day administration to prevent this

Front 40

What are the Adverse effects of steroid use?

Back 40

osteoporosis
cataracts
hyperglycemia
hypokalemia (conteract with K+ supplement0

Front 41

How do steroids cause osteoporosis and how do you counteract the these effects?

Back 41

- they suppress intestinal Ca absorption and inhibit bone formation

-use alternate day dosing
-supplement with Ca and Vit
-Bisphosphonates (Fosamaz) with long term tx

Front 42

What happens if you abruptly stop chronic steroids usage? How should you handle this?

Back 42

- withdrawal b/c the pt experienced HPA suppression
- it causes acute adrenal insufficiency syndrome b/c the adrenal glands are not active
-this can be LETHAL

-taper dosing when discontinuing steroids

Front 43

List the 5 inhibitors of Adrenal Steroids

Back 43

1. Metyrapone
2. Aminoglutethimide
3. Ketoconazole
4. Spironolactone
5. Eplerenone

Front 44

Use of Metyrapone

Back 44

has been replaced by DAST

Front 45

Use of aminoglutethimide

Back 45

-reduces the synthesis of all hormonally active steroids
-treatment of breast ca
-eliminate androgen estrogen production
**Has been widely replaced by Tamoxifin in the tx of breast ca

Front 46

Uses of Ketoconazole

Back 46

- antifungal
-inhibits gonadal and adrenal steroids hormone synthesis

Tx of Cushings

Front 47

Uses of Spironolactone

side effects?

Back 47

-Anti-HTN
-Competes for mineralocorticoid receptors --> inhibits sodium reabsorption
-antagonizes aldosterone and testosterone synthesis

Tx: hyperaldosteronism
hirsutism in women
Side effects: hyperkalemia
gynecomastia

Front 48

Uses of Eplernone

Back 48

-Anti-HTN
-binds to mineralocorticoid receptors
-aldosterone antagonist
-lacks teh unwanted side effects of spironolactone