Overview Cortisol (hydrocortisone) and its synthetic derivatives Drug Gluco corticoid activity Mineralo corticoid activity Duration Cortisol 1 1 Short Prednisone 4 0.3 Medium Triameinolone 5 0 Intermediate Betamethasone 25 0 Long Dexamethasone 30 0 Long Mechanism ↓ the production of leukotrienes and prostaglandins inhibits phospholipase A2 inhibits expression of COX-2 will also stimulate the bone marrow to produce neutrophils resulting in leukocytosis halts inflammatory cascade ↓ leukocyte migration ↓ capillary permeability ↓ phagocytosis ↓ platelet-activating factor ↓ interleukins (e.g. IL-2) may trigger apoptosis in dividing and non-dividing cells used in cancer chemotherapy Clinical use anti-inflammatory immunosuppression cancer chemotherapy (prednisone most common) CLL Hodgkin's lymphomas part of MOPP regimen Addison disease asthma Toxicity must taper dose to avoid toxicity suppression of ACTH → shock state if abrupt withdrawal cortical atrophy malaise myalgia arthralgia fever iatrogenic Cushing syndrome characteristics fat deposition buffalo hump moon facies truncal obesity muscle weakness and atrophy thin skin, easy bruising acne osteoporosis vertebral fractures aseptic hip necrosis ↓ skeletal growth in children hyperglycemia (diabetes) due to ↑ gluconeogenesis glaucoma, cataracts, and other complications can subsequently result ↑ GI acid release ulcers Na+ retention edema, HTN hypokalemia alkalosis hypocalcemia ↓ wound healing ↑ infections mental status changes cataracts
QUESTIONS 1 of 2 1 2 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.EC.14.30) A 67-year-old woman presents to the emergency room with jaw pain and vision loss. The patient reports several weeks of jaw pain, intermittent fevers, and neck pain. This morning she woke up and she couldn't see out of her left eye. The patient has a history of hypertension, hyperlipidemia, and diabetes. Her medications include lisinopril, atorvastatin, and metformin. Fundus examination reveals the following (Figure A). She is started on high dose steroids. She spends the night in the emergency room. On admission, her white count was 8.0. A follow up complete blood count reveals a white count of 18.2 with a neutrophilic predominance. What is the most likely cause of this change? QID: 104036 FIGURES: A Type & Select Correct Answer 1 Bacterial infection 37% (23/63) 2 Malignancy 0% (0/63) 3 Lab error 6% (4/63) 4 Drug effect 51% (32/63) 5 Viral infection 6% (4/63) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
All Videos (1) Login to View Community Videos Login to View Community Videos Glucocorticoids Endocrine - Glucocorticoids D 2/15/2015 69 views 5.0 (2)