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68 Cards in this Set

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What are adrenocorticosteroids?
Steroids produced by the adrenal cortex (endogenous)
What are 2 main types of adrenocoticosteroids?
1) glucocorticosteroids
2) mineralocorticosteroids
What is a physiological dose?
Drug given as a replacement if deficiant
What are 2 ways to describe doses?
1) Physiological
2) Pharmacological
What is a pharmacological dose?
Drug dose that is higher than physiological dose to give the body more than what it naturally produces
Where do catecholamines come from in the adrenal glands?
Medulla cortex
Where do androgens, glucocorticoids, mineralocorticoids come from in the adrenal glands?
Renal cortex
What 3 hormones does cholesterol break down to be?
1) Mineralocorticoids
2) Glucocorticoids
3) Sex hormones

(Structures are similar)
What is the primary steroid produced of glucocorticoids?
Cortisol
What 2 hormones control cortisol synthesis?
1) Corticotropin releasing hormone (CRH)
2) Adrenocorticotropic hormone (ATH)

via negative feedback loop
What is the normal release of cortisol?
Circadian (cyclic)
When is cortisol at its highest during the day?
Morning
When is cortisol released?
During stress
What 2 areas does cortisol affect?
1) Anterior pituitary
2) Hypothalamus

via negative feedback loop
What type of feedback does cortisol use to release?
Negative feedback loop
What is the primary function of cortisol?
Control of glucose metabolism (protein and lipid) and controls body's ability to deal with stress
What are 2 secondary functions of cortisol?
1) Decrease inflammation (key for RA)
2) Suppress immune system
What are 4 other functions of cortisol?
1) Renal
2) CNS
3) Blood
4) Cardiac and skeletal muscle
When is there the lowest levels of cortisol?
During sleep
What 3 types of cells does cortisol affect?
1) Muscle cell
2) Fat cell
3) Liver cell
How does cortisol affect muscle cells? (2)
1) Decrease glucose uptake
2) Increase protein breakdown to form amino acids
How does cortisol affect fat cells?
1) Decrease glucose uptake
2) Increase fat breakdown to form free fatty acids
How does cortisol affect liver cells?
Forms gluconeogenesis (cortisol + amino acids + free fatty acids)
What occurs when gluconeogenesis forms glucose?
Release glucose into the plasma (blood stream)
What type of receptor does glucose (glucocorticoid mechanism) bind to?
Intracellular receptor that travels to the nucleus to produce 2 phase effects (transcription, translation) to form protein synthesis
What are 3 clinical uses or indications for glucocorticoids?
1) Endocrine conditions
2) Primary vs secondary insufficiency (surgically remove adrenals or pituitary gland)
3) Nonendocrine conditions
How are glucocorticoids used for endocrine conditions? (2)
Used as a hormone replacement or to help in diagnosing or evaluating condition
What is a primary insufficiency to use glucocorticoids?
Problem with adrenal cortex destruction (Addison's dz)
What is Addison's Dz?
Problem with adrenal cortex
What is a secondary insufficiency to use glucocorticoids?
Not an adrenal problem, but rather cortex problem
What is an example of a secondary insufficiency to use glucocorticoids?
Lack of ACTH
What are 3 nonendocrine conditions that glucocorticoids are used for?
1) Anti-inflammatory (RA, allergies)
2) Immune suppressant (RA)
3) Antilymphocytic (cancers)
What are 4 ways to administer glucocorticoids?
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)
Why are glucocorticoids given orally for only short-term?
Because there are lots of side effects
What are 3 examples of region/organ specific glucocorticoids?
1) Nasal
2) Topical
3) Ophthalamic
What 2 ways do glucocorticoids often end with?
-sone
-olone
What is adrenocortical suppression?
Decreased or absent production of glucocorticoids due to negative feedback effect
What is important to know about ending the use of glucocorticoids?
Must be tapered, especially after long-term use
What are 6 S/S of drug-induced Cushing syndrome?
1) Round, puffy face
2) Trunk fat deposition
3) Muscle wasting (extremities)
4) Osteoporosis
5) Increased body hair
6) Glucose intolerance
What is the #1 adverse effect of glucocorticoids that influences PT?
Breakdown of supportive tissue such as muscle, tendon, bone and skin
What are 5 PT considerations to the breakdown of supporting tissues from adverse effects of glucocorticoids?
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)
What are 8 other adverse effects of glucocorticoids?
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
What is the primary steroid of mineralocorticoids?
Aldosterone
What is the primary function of aldosterone?
To maintain fluid and electrolyte intake
How does mineralocorticoids affect the kidneys?
Increases Na2+ and H2O reabsoption and K+ excretion in the kidneys
What are the adverse effects of mineralocorticoids?
If prolong or excess production, cardiac and vascular change (leads to CVD)
What drug type controls the adverse effects of mineralocorticoids (cardiovascular changes)?
Antagonists
What are 3 ways to stimulate release of mineralocorticoids (aldosterone)?
1) Increase angiotensin II
2) Increase plasma K+ level to release aldosterone to decrease plasma concentration
3) Increase ACTH
What are 2 phases of effects of aldosterone (mineralocorticoids)?
1) Nuclear
2) Non-nuclear
Describe the nuclear effect of aldosterone (mineralcorticoids)
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
Describe the non-nuclear effect of aldosterone (mineralcorticoids)
No change in protein synthesis
What hormone is key to increase Na2+/H2O reabsorption and K+ secretion/excretion?
Aldosterone
What is the net effect of aldosterone on the kidneys?
Increase Na+/H2O reabsorption and K+ secretion/excretion
What does Na+/K+ active pump do?
Pumps Na+ into the bloodstream to be reabsorbed into circulation and pumps K+ into the lumen to be excreted
What type of therapeutic would aldosterone (mineralocorticoids) be used if the adrenal gland was removed?
Replacement therapy of aldosterone agonists

Can also be used for Addison's Dz
What are 4 adverse effects of aldosterone (mineralcorticoids)?
1) HTN
2) Peripheral edema
3) Weight gain
4) Hypokalemia (lower than normal K+ in bloodstream)
What are 2 examples of aldosterone antagonists?
1) Spironolactone (Aldactone)
2) Eplerenone (Inspra)
What do competitive aldosterone antagonists do?
Oppose normal aldosterone effects by increasing Na+/H2O excretion and decreasing K+ excretion
When would competitive aldosterone antagonists be used to treat? (2)
1) HTN
2) Heart failure
What are competitive aldosterone antagonists also known as?
K+ sparing diuretics
What are 2 adverse effects of competitive aldosterone antagonists?
1) May cause hyperkalemia (increased K+ plasma levels)
2) GI disturbances
What may spironolactone interfere with?
Endogenous sex hormones and can cause CNS effects
What is the primary function of adrenocorticosteroid antagonists?
Inhibit adrenocorticosteroid production
What is the mechanism of adrenocorticosteroid antagnoists?
Block a specific enzyme (one step in the synthesis pathway)
What do adrenocorticosteroid antagonists directly suppress?
Adrenal gland
What results when adrenocorticosteroid antagonists directly suppresses the adrenal gland?
Decreases hormone secretion (either glucocorticoids or mineralocorticoids or both)
What is the primary adverse effect of adrenal steroids?
Breakdown of tissues (muscle, bone, tendon, skin)
What are 3 secondary adverse effects of adrenal steroids?
1) Na+/H2O retention if high aldosterone
2) Immune suppression
3) Toxicity (mood changes)