Steroids (Msq Drill 171)

1. During a stressful situation is cortisol upregulated or downregulated?

Upregulated

Downregulated

2. What is the best time to administer cortisol so that the hypothalamic pituitary axis is not suppressed.

AM

PM

3. The following drugs are all intermediate to long acting gluccocorticoids. Which one is most often used for CNS penetration?

Triamnicolone (kenalog)

Bethamethasone (diprosone)

Dexamethasone

4. Can corticosteroids cause acne?

Yes

No

5. Which part of the adrenal gland produces epinephrine and norpeinephrine?

Medulla

Cortex

6. The production of cortisol/sorticosteroids is highest in the AM or PM?

AM

PM

7. Does cortisol cause a negative feedbacm inhibition of the hypothalamic and pituitary activity?

Yes

No

8. Is cortisol metabolism CYP dependant?

Yes

No

Inducers will lead to a need to increase the amount of cortisol.

Explanation

Inducers will lead to a need to increase the amount of cortisol.

9. So, late phase adrenal suppression occurs at the glucocorticoid receptor?

Yes

No

10. What effect does the mineralocorticoid receptor have on sodium?

Decreases Na+ leading to diuresis, hypovolemia and hypotension

Increases Na+ leading to retention, hypervolemia and hypertension

11. How do we prevent HPA suppression in a patient that has been taking corticosteroids for >7 days?

Stop the medication suddenly in order to drop the levels

Taper the medication

12. Normal non-stresed individuals will produce _______ of cortisol. Stressed individuals will produce up to 200mg/24hrs.

5mg

10-30mg

100mg

150mg

13. Aldosterone or minerlocorticoid is produced in the glomerulosa. True or false?

True

False

14. A patient has an abnormally high level of adrenocroticotropic hormone (ACTH), measuring the CRF will confirm that the pituitary gland is the source of the abnormality. True or false?

True

False

The hypothalamus releases CRF in response to the pituitary gland.

Explanation

The hypothalamus releases CRF in response to the pituitary gland.

15. Does mineralocorcoid cause K+ loss or retention?

K+ loss

K+ retention

16. Taking a gluccocrticoid will increase blood sugar levels. True or false?

Yes, this is due to insulin antagonism

No, it has no effect on blood suar levels

17. What is aldosterone?

Mineralocorticoid

Glucocorticoid

Gonadocroticoid

18. If a patient is taking steroids chronically and then they experience increased stress, will their dose need to be increased or decreased?

Increased

Decreased

19. Does a short term increase of cortisol result in feedback inhibition?

Yes

No

20. Which receptor has more affinity for cortisol, the mineralocorticoid receptor or the gluccocorticoid receptor?

Mineralocorticoid receptor

Gluccocorticoid receptor

21. Fludrocortisone (florinef) is primarily a :

Glucocorticoid

Mineralocorticoid

Gonadocorticoid

22. Methylprednisolone is:

Primarily mineralocorticoid

Mixed

Primary glucorcorticoid and short acting

23. The maximum stress induced production of cortisol is approximately ______ over 7-10 days.

50mg/24hr

100.mg/24hr

150mg/24hr

200mg/24hr

250mg/24hr

24. The ____________ releases corticotropin releasing factor when cortisol level is low.

Hypothalamus

Pituitary gland

Adrenal gland

25. Where does initial suppression of the HPA axis start?

Mineralocorticoid receptor

Gluccocorticoid receptor

26. Glucocorticoids are involved in the following functions>

Gluconeogenesis

Protein anabolism

Protein catabolism

Lipolysis

Submit

27.
Above suprophysiologc doses cortisol will cuase feedback inhibition. What is considered a suproaphyisiologic dose of cortisol?

>20mg hydrocortison/day

>30mg hydrocortisone/day

>40mg hydrocortisone/day

28. Gluccocorticoids are produced in the:

Glomerulosa

Fasciculata

Reticularis

29. Which of the following is/are produce in the reticularis

Aldosterone

Gonadocorticoids

30. If adrenocorticosteroids are low, the pituitary gland releases ACTH which will cause an increased production of adrenocroticosteroids by the:

Adrenal medulla

Adrenal cortex

31. Hydrocortisone, cortisone and prednisone are:

Primarily mineralocorticoid

Mixed

Primarily glococorticoid

32. Glucocorticoid also have the following functions:

Anti inflammatory

Decreased anti body production & cytokines

Decreased WBC margination (leukocytosis)

Decreased COX 2 expression

Increased apoptosis in neoplams

Submit

33. Gluccorcoticoids cause insuloin antagonism, therefore there is more circulating blood sugar leading to more fat deposition or redistribution of fat. What are common names used to describe this phenomenon?

Moon face

Buffalo hump

Cauliflower ears

Cushingoid

Submit

34. The adrenal cortex produces adrenal corticosteroids. Namely these are:

Aldosterone

Glucocorticoids

Gonadocorticoids

Mineralocorticoid

Prednisone

mineralocorticoid is aldosterone.

Explanation

mineralocorticoid is aldosterone.

Submit

35. Which of the following are involved in the hypothalamic-pituitary-adrenal axis?

Corticotropin releasing factor (CRF)

Adrenocorticotropic hormone

Cortisol

Thyroid stimulating hormone

Submit

36. Do corticosteroids cause sedation?

Yes, they can cuse sedation

No, they actually cause agitation

37. Adrenocorticotropic hormone is released by the pituitary gland. It also causes an increase in mealnin production and hyperpigmentation. When it does this is it acting as _________ .

Melanin

Melatonin

A melanocortin

This explains why patients with primary Addison's disease have hyperpigmentation.

Explanation

This explains why patients with primary Addison's disease have hyperpigmentation.