Pt 713 Adrenocorticosteroids

Front 1

What are adrenocorticosteroids?

Back 1

Steroids produced by the adrenal cortex (endogenous)

Front 2

What are 2 main types of adrenocoticosteroids?

Back 2

1) glucocorticosteroids
2) mineralocorticosteroids

Front 3

What is a physiological dose?

Back 3

Drug given as a replacement if deficiant

Front 4

What are 2 ways to describe doses?

Back 4

1) Physiological
2) Pharmacological

Front 5

What is a pharmacological dose?

Back 5

Drug dose that is higher than physiological dose to give the body more than what it naturally produces

Front 6

Where do catecholamines come from in the adrenal glands?

Back 6

Medulla cortex

Front 7

Where do androgens, glucocorticoids, mineralocorticoids come from in the adrenal glands?

Back 7

Renal cortex

Front 8

What 3 hormones does cholesterol break down to be?

Back 8

1) Mineralocorticoids
2) Glucocorticoids
3) Sex hormones

(Structures are similar)

Front 9

What is the primary steroid produced of glucocorticoids?

Back 9

Cortisol

Front 10

What 2 hormones control cortisol synthesis?

Back 10

1) Corticotropin releasing hormone (CRH)
2) Adrenocorticotropic hormone (ATH)

via negative feedback loop

Front 11

What is the normal release of cortisol?

Back 11

Circadian (cyclic)

Front 12

When is cortisol at its highest during the day?

Back 12

Morning

Front 13

When is cortisol released?

Back 13

During stress

Front 14

What 2 areas does cortisol affect?

Back 14

1) Anterior pituitary
2) Hypothalamus

via negative feedback loop

Front 15

What type of feedback does cortisol use to release?

Back 15

Negative feedback loop

Front 16

What is the primary function of cortisol?

Back 16

Control of glucose metabolism (protein and lipid) and controls body's ability to deal with stress

Front 17

What are 2 secondary functions of cortisol?

Back 17

1) Decrease inflammation (key for RA)
2) Suppress immune system

Front 18

What are 4 other functions of cortisol?

Back 18

1) Renal
2) CNS
3) Blood
4) Cardiac and skeletal muscle

Front 19

When is there the lowest levels of cortisol?

Back 19

During sleep

Front 20

What 3 types of cells does cortisol affect?

Back 20

1) Muscle cell
2) Fat cell
3) Liver cell

Front 21

How does cortisol affect muscle cells? (2)

Back 21

1) Decrease glucose uptake
2) Increase protein breakdown to form amino acids

Front 22

How does cortisol affect fat cells?

Back 22

1) Decrease glucose uptake
2) Increase fat breakdown to form free fatty acids

Front 23

How does cortisol affect liver cells?

Back 23

Forms gluconeogenesis (cortisol + amino acids + free fatty acids)

Front 24

What occurs when gluconeogenesis forms glucose?

Back 24

Release glucose into the plasma (blood stream)

Front 25

What type of receptor does glucose (glucocorticoid mechanism) bind to?

Back 25

Intracellular receptor that travels to the nucleus to produce 2 phase effects (transcription, translation) to form protein synthesis

Front 26

What are 3 clinical uses or indications for glucocorticoids?

Back 26

1) Endocrine conditions
2) Primary vs secondary insufficiency (surgically remove adrenals or pituitary gland)
3) Nonendocrine conditions

Front 27

How are glucocorticoids used for endocrine conditions? (2)

Back 27

Used as a hormone replacement or to help in diagnosing or evaluating condition

Front 28

What is a primary insufficiency to use glucocorticoids?

Back 28

Problem with adrenal cortex destruction (Addison's dz)

Front 29

What is Addison's Dz?

Back 29

Problem with adrenal cortex

Front 30

What is a secondary insufficiency to use glucocorticoids?

Back 30

Not an adrenal problem, but rather cortex problem

Front 31

What is an example of a secondary insufficiency to use glucocorticoids?

Back 31

Lack of ACTH

Front 32

What are 3 nonendocrine conditions that glucocorticoids are used for?

Back 32

1) Anti-inflammatory (RA, allergies)
2) Immune suppressant (RA)
3) Antilymphocytic (cancers)

Front 33

What are 4 ways to administer glucocorticoids?

Back 33

1) Oral (systemic) for short-term
2) Injected intra-articularly or epidurally
3) Possibly systemically for long-term (controversial)
4) Region/organ specific (nasal, topical, ophthalamic)

Front 34

Why are glucocorticoids given orally for only short-term?

Back 34

Because there are lots of side effects

Front 35

What are 3 examples of region/organ specific glucocorticoids?

Back 35

1) Nasal
2) Topical
3) Ophthalamic

Front 36

What 2 ways do glucocorticoids often end with?

Back 36

-sone
-olone

Front 37

What is adrenocortical suppression?

Back 37

Decreased or absent production of glucocorticoids due to negative feedback effect

Front 38

What is important to know about ending the use of glucocorticoids?

Back 38

Must be tapered, especially after long-term use

Front 39

What are 6 S/S of drug-induced Cushing syndrome?

Back 39

1) Round, puffy face
2) Trunk fat deposition
3) Muscle wasting (extremities)
4) Osteoporosis
5) Increased body hair
6) Glucose intolerance

Front 40

What is the #1 adverse effect of glucocorticoids that influences PT?

Back 40

Breakdown of supportive tissue such as muscle, tendon, bone and skin

Front 41

What are 5 PT considerations to the breakdown of supporting tissues from adverse effects of glucocorticoids?

Back 41

1) Amount of work or potential injury there is to a muscle
2) Pressure ulcers
3) Check for fx (OP)
4) Endurance may change with dose
5) Watch glucose changes (hypo-hyper)

Front 42

What are 8 other adverse effects of glucocorticoids?

Back 42

1) Peptic ulcers
2) Growth retardation
3) Glaucoma
4) Mood changes and psychoses
5) Susceptibility to infections
6) HTN
7) Cataracts
8) Aggravation of DM

Front 43

What is the primary steroid of mineralocorticoids?

Back 43

Aldosterone

Front 44

What is the primary function of aldosterone?

Back 44

To maintain fluid and electrolyte intake

Front 45

How does mineralocorticoids affect the kidneys?

Back 45

Increases Na2+ and H2O reabsoption and K+ excretion in the kidneys

Front 46

What are the adverse effects of mineralocorticoids?

Back 46

If prolong or excess production, cardiac and vascular change (leads to CVD)

Front 47

What drug type controls the adverse effects of mineralocorticoids (cardiovascular changes)?

Back 47

Antagonists

Front 48

What are 3 ways to stimulate release of mineralocorticoids (aldosterone)?

Back 48

1) Increase angiotensin II
2) Increase plasma K+ level to release aldosterone to decrease plasma concentration
3) Increase ACTH

Front 49

What are 2 phases of effects of aldosterone (mineralocorticoids)?

Back 49

1) Nuclear
2) Non-nuclear

Front 50

Describe the nuclear effect of aldosterone (mineralcorticoids)

Back 50

Aldosterone binds to intracellular receptor to cause changes in the nucleus which increases protein Na2+ channel synthesis (increasing Na2+ membrane permeability facing lumen)

Slower effect with change in protein synthesis

Front 51

Describe the non-nuclear effect of aldosterone (mineralcorticoids)

Back 51

No change in protein synthesis

Front 52

What hormone is key to increase Na2+/H2O reabsorption and K+ secretion/excretion?

Back 52

Aldosterone

Front 53

What is the net effect of aldosterone on the kidneys?

Back 53

Increase Na+/H2O reabsorption and K+ secretion/excretion

Front 54

What does Na+/K+ active pump do?

Back 54

Pumps Na+ into the bloodstream to be reabsorbed into circulation and pumps K+ into the lumen to be excreted

Front 55

What type of therapeutic would aldosterone (mineralocorticoids) be used if the adrenal gland was removed?

Back 55

Replacement therapy of aldosterone agonists

Can also be used for Addison's Dz

Front 56

What are 4 adverse effects of aldosterone (mineralcorticoids)?

Back 56

1) HTN
2) Peripheral edema
3) Weight gain
4) Hypokalemia (lower than normal K+ in bloodstream)

Front 57

What are 2 examples of aldosterone antagonists?

Back 57

1) Spironolactone (Aldactone)
2) Eplerenone (Inspra)

Front 58

What do competitive aldosterone antagonists do?

Back 58

Oppose normal aldosterone effects by increasing Na+/H2O excretion and decreasing K+ excretion

Front 59

When would competitive aldosterone antagonists be used to treat? (2)

Back 59

1) HTN
2) Heart failure

Front 60

What are competitive aldosterone antagonists also known as?

Back 60

K+ sparing diuretics

Front 61

What are 2 adverse effects of competitive aldosterone antagonists?

Back 61

1) May cause hyperkalemia (increased K+ plasma levels)
2) GI disturbances

Front 62

What may spironolactone interfere with?

Back 62

Endogenous sex hormones and can cause CNS effects

Front 63

What is the primary function of adrenocorticosteroid antagonists?

Back 63

Inhibit adrenocorticosteroid production

Front 64

What is the mechanism of adrenocorticosteroid antagnoists?

Back 64

Block a specific enzyme (one step in the synthesis pathway)

Front 65

What do adrenocorticosteroid antagonists directly suppress?

Back 65

Adrenal gland

Front 66

What results when adrenocorticosteroid antagonists directly suppresses the adrenal gland?

Back 66

Decreases hormone secretion (either glucocorticoids or mineralocorticoids or both)

Front 67

What is the primary adverse effect of adrenal steroids?

Back 67

Breakdown of tissues (muscle, bone, tendon, skin)

Front 68

What are 3 secondary adverse effects of adrenal steroids?

Back 68

1) Na+/H2O retention if high aldosterone
2) Immune suppression
3) Toxicity (mood changes)