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Pharmacology Exam V > Adrenal Agents > Flashcards

Adrenal Agents Flashcards

1
Q

Adrenal Gland Cortex synthesis

A

Mineralocorticoids
Glucocorticoids
Androgens

(all three considered corticosteroids)

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2
Q

Adrenal Gland Medulla Synthesis

A

Epinephrine

Norepinephrine

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3
Q

Mineralocorticoid?

function?

physiologic importance?

A

Aldosterone

increases Na reabsoprtion at renal collecting tubule

BP regulation

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4
Q

Glucocorticoid?

function?

Physiologic importance?

A

Cortisol

Restoring homeostasis after exposure to stresses

Important under normal conditions and is released under a circadian rhythm
Increases blood glucose levels and numerous other metabolic effects
Counter balance to immune system (antiinflammatory actions)
Facilitates epinephrine and norepinephrine responses

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5
Q

Drug Targets for Corticosteroid Biosynthesis

Common genetic disease?

A

17-alpha hydroxylase

11-beta hydroxylase

21-hydroxylase deficiency

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6
Q

Hypothalamus releases

A

corticotropin releasing hormone (CRH)

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7
Q

Anterior Pituitary release

A

activates GPCR’s on corticotropic cells

Rapid secretion of pre-formed ACTH

slower increase in ACTH pre-cursor synthesis

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8
Q

ACTH effect on Adrenal cortex

A

ACTH activates adrenal cortical cell receptors

Increases steroidogenic enzymes and secretion of cortical steroids

production of CORTISOL AND ADRENAL ANDROGENS

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9
Q

Glucocorticoid and Mineralocorticoid receptors

A

NUCLEAR HORMONE RECEPTORS

gluco and mineralocorticoids diffuse across cellular membranes to bind

receptors then TRANSLOCATE TO NUCLEUS

INCREASE OR DECREASE GENE EXPRESSION

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10
Q

Cortisol does what?

What enzyme inactivates cortisol? what’s the product?

What enzyme does the opposite?

A

binds both mineralocorticoid and glucocorticoid receptors and activates

11-beta hydroxysteroid dehydrogenase type II

cortisone

11-beta-hydroxysteroid dehydrogenase type I

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11
Q

11-beta hydroxylase type I important for?

action occurs mainly where?

A

activation of prodrugs of glucocorticoids

LIVER

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12
Q

Addisons Disease - deficiency of what?

tx?

A

deficiency in cortisol, aldosterone, and androgens

ACTH, CRH levels ELEVATED

ORAL CORTISOL

FLUDROCORTISONE

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13
Q

Secondary adrenal insufficiency - two types?

characteristics of each?

tx?

A

pituitary disease - DECREASE IN ACTH - increase in CRH

hypothalamic disease - DECREASE IN CRH - decrease in ACTH

CORTISOL - fludrocortisone not needed

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14
Q

Short acting corticosteroids

A

hydrocortisone

cortisone

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15
Q

Intermediate acting corticosteroids

A

prednisone

prednisolone

methylprednisolone

triamcinolone

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16
Q

Long acting corticosteroids

A

betamethasone

dexamethasone

17
Q

Mineralocorticoid drug

A

fludrocortisone

18
Q

Cushing syndrome

causes?

A

chronic glucocorticoid excess

Chronic glucocorticoid therapy
Pituitary tumor that causes hypersecretion of ACTH
Ectopic hypersecretion of ACTH by non-pituitary tumors
Adrenal tumor that hypersecretes cortisol

19
Q

Dexamethasone test for cause of Cushing’s - 3 causes other than chronic glucocorticoid therapy - DIFFERENTIATE

A

Pituitary hypersecretion of ACTH - DECREASE CRH, INCREASE ACTH - 50% reduction in cortisol

Adrenal adenoma - DECREASES BOTH CRH, ACTH - no cortisol reduction

Ectopic ACTH Production - DECREASE CRH, INCREASE ACTH - no cortisol reduction

20
Q

Ketoconazole MOA in cushings tx

A

INHIBITS 17-ALPHA HYDROXYLASE

decrease production of cortisol pre-cursors

liver toxicity

21
Q

Metyrapone MOA

uses

A

inhibits 11-beta hydroxylase

diagnostic in ACTH PRODUCTION EVALUATION

off label tx for cushing’s

22
Q

Mifepristone MOA

A

GLUCOCORTICOID RECEPTOR ANTAGONIST - higher doses

terminate pregnancy at lower doses

treat INOPERABLE PATIENTS with ectopic ACTH secretion or adrenal carcinoma

23
Q

Glucocorticoid effects on immune cells (5)

A

apoptosis of eosinophils

decrease t cell proliferation

inhibit mast cell degranulation and contents release

stabilization of lysosomal membranes in neutrophils

decrease activation of macrophages and cytokine release

24
Q

Glucocorticoid mechanisms of anti-inflammatory actions (5)

A

inhibit phospholipase A2

inhibit COX

inhibit NO synthase

inhibit cytokine production

vasoconstriction

25
Q

Inhaled corticosteroids (4)

A

Budesonide
Fluticasone
Mometasone
Triamcinolone

26
Q

MOA of inhaled corticosteroids (4)

A

decrease leakiness of vascular endothelial cells

reduce growth of airway smooth muscle

decrease adhesion of airway epithelial cell molecule

increase epithelial integrity

27
Q

Beta-2 agonist and corticosteroid interaction

A

corticosteroids INCREASE BETA-2 RECEPTOR EXPRESSION - prevents desensitization

beta-2 agonists INCREASE NUCLEAR TRANSLOCATION OF GR’s - increase binding

28
Q

Metabolism of glucocorticoids occurs mainly in?

A

LIVER

excreted in urine

29
Q

Adverse effects of glucocorticoid therapy (name some)

A 
decrease growth in children
osteoporosis
increased appetite
glaucoma
increased infection risk
emotional disturbances
centripetal fat 
increased diabetes risk
hypokalemia
HTN
peripheral edema
30
Q

Things that decrease effect of glucocorticoids

A

p450 inducers - barbiturates, carbamazepine, rifampin

31
Q

Things that increase effect of glucocorticoids

A

estrogens, androgens compete for metabolism

concurrent use with cyclosporin - increase levels of each other

Pharmacology Exam V (11 decks)

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