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Endocrine Pharm > Adrenal Agents > Flashcards

Adrenal Agents Flashcards

1
Q

What are the layers of the Adrenal glands?

What do they Produce?

A 
Cortex
-Mineralocorticoids (Ald)
-Glucocorticoids(Hydcort)
-Androgens
Medulla
-Epi
-Nori
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2
Q

What is the function of Mineralocoirticoids?

A

.

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3
Q

What is the function of Glucocoirticoids?

A

.

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4
Q

What is the function of Androgens?

A

.

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5
Q

What is included in the HPA Axis?

A

Hypothalamus
Anterior Pituitary
Adrenal Cortex

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6
Q

What does the Hypothalamus Secrete?

A

CRH(Corticotropin rel. Hiormone)

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7
Q

What does the Ant. Pituitary Secrete?

A

GPCRs activated by CRH

Secretion of preformed ACTH/slower increase in synth of ATCH

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8
Q

What does the Adrenal Cortex secrete?

A

.

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9
Q

What is the Enzyme in Mineralocoirticoid responsive tissues?

A

Type 2 isoform of 11B-Hydroxysteroid Dehydrogenase

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10
Q

What effect does elevated cortisol levels have?

A

11B-HSD2 becomes saturated

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11
Q

What are the Short acting Corticosteroid Drugs?

A

Hydrocortisone

Cortisone

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12
Q

What are the Int acting Corticosteroid Drugs?

A

Prednisone
Prednisolone
Methyl Prednisolone
Triamcinolone

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13
Q

What are the Long acting Corticosteroid Drugs?

A

Beta methasone

Dexamethasone

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14
Q

What type of glucocorticoid is Fludrocortisone?

A

Mineralocorticoid

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15
Q

Waht is the cause of Addison’s disease?

A

Primary adrenal insufficiency caused by

Autoimmune or TB

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16
Q

What are the evvects of Addison’s disease?

A

Def in Cortisol, aldosterone, and androgens
ACTH and CRH are elevated
Hypotension (unresp. of vascular SM to catecholamines)

17
Q

What is the Tx of Addison’s diseae?

A

Oral cortisol

and Fludrocortisone

18
Q

What causes Secondary Adrenal Insufficiency?

A

Pituitary Disease
-dec in ACTH increase in CRH, dec in cortisol
Hypothalmic Disease
-Dec in CRH, dec in ATCH, dec in cortisol

19
Q

Tx for 2nd Ad Insuff?

A

Cortisol

No Fludrocortisone needed

20
Q

What happens whe there si Corticosteroid Excess?

A

Cushing Syndrome

Symptoms?

21
Q

What are the causes of Cushing syndromes?

A

Chronic Glucocorticoid Therapy
Pit. Tumor inc secretion of ACTH
Adrenal tumor that hypersecretes cortisol

22
Q

How is Dexamethasone used as a diagnostic tool?

What are the signs?

A

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

23
Q

What is the Use of Ketoconazole?

A

Antifungal
Inhibits 17ahydroxylase
Tx for cushing synd
Liver TOX!

24
Q

What is the Use of Metyrapone?

A

Diagnostic Agent to eval. ACTH prod

Tx. Cushing synd

25
Q

What is the Use of Mifespristone?

A

Anti Progestin. Terminates Pregnancy
Glc receptor agonist at higher doses
Ectopic ACTH secretion when inoperable

26
Q

What are other uses of Glucocorticoids?

A

.

27
Q

What are the effecs of Glucocorticoids on Immune cells?

A

Inhibit activation, and release of immune cytokines

28
Q

What are the inhaled meds used for asthma?

A

if using a B2 receptor agonists more than 2x per week

add a glucocorticoid

29
Q

what is the MOA of inhaled Corticosteroids?

A

Reduce histamine production, decrease activity of airway SM cells
Decrease mucous production

30
Q

What are the adverse effects of Glucocorticoids?

A

Stunt growth of children with high doses
Dysphonia
Oropharyngeal Candidiasis
cough

31
Q

What are the pharmacodynamic facors with glucocorticoids?

A

.

32
Q

Why must a person be transitioned off of Glucocorticoids slowly?

A

HPA axis supression can take up to a year to recover from. May be deadly!

33
Q

How can HPA Axis supression be minimized?

A 
Short acting
Lower dose
Short duration
non-systemic routes
Single AM dose
Alternate day regimen
Taper it off
34
Q

What effect do p450 inducers have on GLucocorticoids?

A

Increase metabolism

35
Q

What fators increase the effect of GLC?

A

estrogens and androgens compete

GLC and Cyclosporins increase levels of each other

36
Q

What enzyme Activates/Inactivates Cortisol to Cortisone

A

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

Endocrine Pharm (11 decks)

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