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Pharm- Exam 2 > Adrenal > Flashcards

Adrenal Flashcards

1
Q

What is Aldosterone primarily under the influence of?

A

Angiotensin

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2
Q

What are the physiological effects of adrenal hormones?

A
  1. Metabolism
  2. CV Function
  3. Growth
  4. Immunity
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3
Q

When does Cortisol peak?

A
  1. AM

2. After meals: LUNCH!

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4
Q

What is the role of corticosteroid-binding globulin (CBG)?

A

Binds 90% of circulating cortisol

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5
Q

When do we see an increase in CBG?

A
  1. Pregnancy
  2. Estrogen admin
  3. HYPERthyroidism
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6
Q

When do we see an decrease in CBG?

A
  1. Genetic defects
  2. Protein deficiency states
  3. HYPOthyroidism
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7
Q

What is Dexamethasone largely bound to?

A

Albumin

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8
Q

List the effects of a fasting state

A

Save the glucose for the brain:

  1. Gluconeogenesis
  2. Release of amino acids from muscle catabolism
  3. Lipolysis
  4. INHIBITION of peripheral glucose uptake*
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9
Q

What is the half life of cortisol?

A

60-90 minutes

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10
Q

How can we increase/improve the half life of cortisol?

A
  1. Administering LARGER AMOUNTS of hydrocortisone
  2. Stress
  3. Hypothyroidism
  4. Liver disease
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11
Q

Where is cortisol metabolized?

A

Liver

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12
Q

Who do we MCly see Adrenal Crisis in?

A

Primary Adrenal Insufficiency: Addison’s Dz

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13
Q

Adrenal Crisis si/sx’s

A
  1. Low BP*
  2. Hyperpigmentation*
  3. N/V/D
  4. Dehdrydation
  5. Abd Pain
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14
Q

How we test for Adrenal Crisis? Findings?

A

Cosyntropin Stimulation Test: No increase in cortisol

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15
Q

Adrenal Criss Treatment

A

IV Hydrocortisone (glucocorticoid) + Glucose+ IV Saline

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16
Q

Define Addisons Disease

A
  1. Primary adrenal insufficiency
  2. Etiology: Autoimmune
  3. Dysfunction/Absence of adrenal cortices: LACK of cortisol and aldosterone
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17
Q

Addison’s Dz si/sx

A
  1. Hypotension
  2. Hyperpigmentation
  3. Low Na+
  4. High K+, Ca++, BUN
  5. Small heart
  6. Low cortisol, High ACTH
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18
Q

Addison’s Dz treatment

A
  1. Glucocorticoids: Oral Hydrocortisone

2. +/- Mineralcorticoids: Fludrocortisone

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19
Q

When would you add/increase Fludrocortisone?

A
  1. Hyperkalemia
  2. Hypotension
  3. Fatigue
20
Q

When would you take away/decrease Fludrocortisone?

A
  1. Hypokalemia
  2. Hypertension
  3. Edema
21
Q

What are the effects of DHEA in Addison’s Dz?

A
  1. Improved well being
  2. Increased muscle mass
  3. Reversal fo bone loss @ femoral neck
22
Q

What do you need to monitor in older women who are using DHEA?

A

Androgenic effects

23
Q

What are the effects of Prednisone?

A
  1. Adrenal Suppression
  2. Growth Inhibition
  3. Muscle Wasting
  4. Osteoporosis
  5. Salt retention
  6. Glucose intolerance
24
Q

MCC for Cushing’s syndrome (excessive cortisol)?

A

Exogenous Administration

25
Other causes for Cushing's syndrome
1. ACTH Hypersecretion from pituitary | 2. Pituitary Adenoma
26
Cushing Syndrome Test
1. Dexamethasone Suppresion test: No cortisol Suppression | 2. 24 hr urinary free cortisol
27
Iatrogenic steroid therapy treatment
gradual steroid taper
28
Ectopic ACTH treatment
1. Surgical: Tumor Removal | 2. Drugs: Metryapone, Ketoconazole
29
Metryapone and Ketoconazole MOA
Blocks production of cortisol
30
Ketoconazole drug interaction
CYP3A4 substrate and inhibitor
31
Pituitary adenoma treatment
1. Surgical Transphenoidal resection | 2. Drugs: Mitotane, Mifepristone, Metyrapone, Cabergoline, Pasireotide
32
Mitotane MOA
Adreneolytic
33
Mifepristone MOA
Glucocoritocids antagonist
34
Pasireotide MOA
Somatostatin analog: Inhibits ACTH secretion
35
What must you rule out in a female before you start them on Mifepristone? Why?
Pregnancy testing d/t abortifacent
36
Primary Hyperaldoseronism etiology
Conn's Syndrome: Aldosterone Producing Adrenal Adenoma
37
Secondary Hyperaldoseronism etiology
Increased Renin and increased Angiotension II
38
Hyperaldoseronism si/sx's
1. HTN 2. Hypokalemia 3. Hypernatremia 4. Polyuria, Polydipsia 5. Tetany/Paralysis
39
List the 3 drugs used in the treatment of Hyperaldoseronism
1. Amiloride 2. Eplernone 3. Spirnolactone
40
List the drugs that have hyperkalemia and hypotension as a SE in the tx of Hyperaldoseronism
1. Amiloride 2. Eplernone 3. Spirnolactone
41
List the drugs that have GI upset as a SE in the tx of Hyperaldoseronism
1. Amiloride | 2. Sprinolactone
42
List the drugs that have HA as a SE in the tx of Hyperaldoseronism
1. Amiloride | 2. Eplernone
43
List the drug that has Dizziness as a SE in the tx of Hyperaldoseronism
Eplernone
44
List the drugs that has Gynecomastia and mentrual irregularities as a SE in the tx of Hyperaldoseronism
1. Eplernone | 2. Spirnolactone
45
What do you need to monitor with the drug treatment in Hyperaldoseronism
1. Hyperkalemia 2. BP: Hypotension 3. Serum Creatinine
46
Eplernone drug interaction
CYP3A4 substrate: Avoid with CYP3A4 inhibitors

Pharm- Exam 2 (5 decks)

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