Adrenal Agents Flashcards
What are the layers of the Adrenal glands?
What do they Produce?
Cortex -Mineralocorticoids (Ald) -Glucocorticoids(Hydcort) -Androgens Medulla -Epi -Nori
What is the function of Mineralocoirticoids?
.
What is the function of Glucocoirticoids?
.
What is the function of Androgens?
.
What is included in the HPA Axis?
Hypothalamus
Anterior Pituitary
Adrenal Cortex
What does the Hypothalamus Secrete?
CRH(Corticotropin rel. Hiormone)
What does the Ant. Pituitary Secrete?
GPCRs activated by CRH
Secretion of preformed ACTH/slower increase in synth of ATCH
What does the Adrenal Cortex secrete?
.
What is the Enzyme in Mineralocoirticoid responsive tissues?
Type 2 isoform of 11B-Hydroxysteroid Dehydrogenase
What effect does elevated cortisol levels have?
11B-HSD2 becomes saturated
What are the Short acting Corticosteroid Drugs?
Hydrocortisone
Cortisone
What are the Int acting Corticosteroid Drugs?
Prednisone
Prednisolone
Methyl Prednisolone
Triamcinolone
What are the Long acting Corticosteroid Drugs?
Beta methasone
Dexamethasone
What type of glucocorticoid is Fludrocortisone?
Mineralocorticoid
Waht is the cause of Addison’s disease?
Primary adrenal insufficiency caused by
Autoimmune or TB
What are the evvects of Addison’s disease?
Def in Cortisol, aldosterone, and androgens
ACTH and CRH are elevated
Hypotension (unresp. of vascular SM to catecholamines)
What is the Tx of Addison’s diseae?
Oral cortisol
and Fludrocortisone
What causes Secondary Adrenal Insufficiency?
Pituitary Disease
-dec in ACTH increase in CRH, dec in cortisol
Hypothalmic Disease
-Dec in CRH, dec in ATCH, dec in cortisol
Tx for 2nd Ad Insuff?
Cortisol
No Fludrocortisone needed
What happens whe there si Corticosteroid Excess?
Cushing Syndrome
Symptoms?
What are the causes of Cushing syndromes?
Chronic Glucocorticoid Therapy
Pit. Tumor inc secretion of ACTH
Adrenal tumor that hypersecretes cortisol
How is Dexamethasone used as a diagnostic tool?
What are the signs?
Hyp sec of ACTH> Dec CRH, inc in ACTH, 50% dec in cortisol
Adrenal Adenoma> Dec CRH, Dec ACTH, No red in cortisol
Ectopic ACTH > Dec CRH, Inc ACTH, no red in cortisol
What is the Use of Ketoconazole?
Antifungal
Inhibits 17ahydroxylase
Tx for cushing synd
Liver TOX!
What is the Use of Metyrapone?
Diagnostic Agent to eval. ACTH prod
Tx. Cushing synd
What is the Use of Mifespristone?
Anti Progestin. Terminates Pregnancy
Glc receptor agonist at higher doses
Ectopic ACTH secretion when inoperable
What are other uses of Glucocorticoids?
.
What are the effecs of Glucocorticoids on Immune cells?
Inhibit activation, and release of immune cytokines
What are the inhaled meds used for asthma?
if using a B2 receptor agonists more than 2x per week
add a glucocorticoid
what is the MOA of inhaled Corticosteroids?
Reduce histamine production, decrease activity of airway SM cells
Decrease mucous production
What are the adverse effects of Glucocorticoids?
Stunt growth of children with high doses
Dysphonia
Oropharyngeal Candidiasis
cough
What are the pharmacodynamic facors with glucocorticoids?
.
Why must a person be transitioned off of Glucocorticoids slowly?
HPA axis supression can take up to a year to recover from. May be deadly!
How can HPA Axis supression be minimized?
Short acting Lower dose Short duration non-systemic routes Single AM dose Alternate day regimen Taper it off
What effect do p450 inducers have on GLucocorticoids?
Increase metabolism
What fators increase the effect of GLC?
estrogens and androgens compete
GLC and Cyclosporins increase levels of each other
What enzyme Activates/Inactivates Cortisol to Cortisone
11 B Hydroxysteroid Dehydrogenase Type 2: converts active Cortisol to Inactive Cortisone (canbecome saturated if cortisol levels rise.)
11 B Hydroxysteroid Dehydrogenase Type 1: Cortisone back to the active cortisol
