Adrenal Flashcards
Metyrapone: what is it used to treat? Two circumstances? Mechanism? Two consequences? Relevance?Two side effects?
Cushings. Inhibits 11B-hydoxylase. Control of Cushings prior to surgery or post radiotherapy. ACTH secretion increased and plasma deoxycortisol increased- no negtaive feedback on the hypothalamus- pituitary -adrenal axis. Hypertension and hirsutism.
Ketoconazole: what was it used for? What is it used for now (2)? Mechanism? Administration? Side effects/concern?
Antifungal. Hyperadrnealism (supressed steroidogenesis) prior to surgery or post-radiotherapy. Inhibits cytochrome P450 scc. Orally active. Liver damage.
Spironalactone- what is it used for? Mechanism? Adminsitered? Side effects (2)? What is the difference with epleronone?
Primary hyperaldosteronism (Conn/s). Converted to carenone which is a competitive antagonist of the MR receptor. Hence blocks Na resorption and K excretion. Oral administration. Menstrual irregularities and gynaecomastia. Epleronone has similar affinity to the MR but less affinity for androgen receptors, so fewer side effects, better tolerated.
Hydrocortisone- what is it? Describe its MR activity. Adminsitration (2). Pharmacokinetics (2). What does it treat? (4). In congenital adrenal hyperplasia, name 3 special circumstances and 1 pice of patient advice.
A glucocorticoid with MR affinity at high doses.Can be administered either orally or parenterally. Bind to CBG, duration of action 8hours. Can treat primary adrenocortical failure (with fludrocortisone), secondary adrenocortical failure, addisonian crisis (IV) and congenital adrenal hyperplasia. 3 special circumstnaces- when the patient is vulnerable to stress, when ill (x2) and pre- and during surgery. Advise the patient to carry a steroid alert card and wear a MedicAlert bracelet.
Prednisolone- what is it? Describe its MR activity. Administration? Pharmacokinetics (2).
A glucocorticoid with weak MR affinity .Can be administered orally only. Bind to CBG, duration of action 12 hours.
Dexamethasone- what is it? Prednisolone- what is it? Describe its MR activity. Administration? Pharmacokinetics (2). What is it used for (2)?
A synthetic glucocorticoid with no MR affinitys.Can be administered either orally or parenterally. Bind to CBG, duration of action 40 hours. Can treat primary congenital adrenal hyperplasia (instead of hydrocortisone) and is used as a suppression test to confirm Cushing’s syndrome.
Fludromethasone- what is it? Administration. What is it used to treat (2)?
An aldosterone analogue. Administered orally. Treats primary adrenocortical failure and congenital adrenal hyperplasia.
