Adrenal Agents Flashcards
Pharmacological uses for glucocorticoids
Adrenal disorders Anti-inflammatory Immunosuprressant Asthma Hypersensitivity Autoimmune GVHD Neoplasms Lung maturation
GCC Prodrugs activated in liver
Cortisone (cortisol)
Prednisone (Prenisolone)
Long acting GCC
Bethmethasone
Dexamethasone
No salt-retaining effect
Intermediate acting GCC
Prednisone
Prednisolone
Methylprednisolone
Triamcinolone
Short acting GCC
Hydrocortisone
Cortisone
Mineralocorticoid w/strong salt retaining effect
Fludrocortisone
AE Large dose GCC
Decreased growth Glaucoma Centralized body fat Osteoporosis Infections Increased DM Increased appetite Hypokalemia HTN ulcers
AE GCC Therapy
HPA axis suppression
taper off - short acting, low dose, short duration, non-systemic, single dose, alternate day
GCC interactions
Exacerbate HTN drugs - mineralocorticoid Na/K
Exacerbate diuretics - K excretion
NSAID co-administration - ulcers
Reduce effects: hypoglycemic, BP, glaucoma
Addison’s Disease
Low cortisol, aldosterone, androgens
High ACTH, CRH
TX: oral cortisol (high) and fludrocortisone (aldosterone)
Secondary Adrenal Insufficiency
Low ACTH, CRH, cortisol
TX: oral cortisol
Pituitary Hypersecretion of ACTH
low CRH, increased ACTH, high cortisol
50% reduction after Dexamethasone
Adrenal adenoma
Low CRH/ACTH, high cortisol
no reduction after Dexamethasone
Ectopic ACTH
decreasd CRH, increased ACTH, high cortisol
no reduction after Dexamethasone
MOA Metyrapone
Inhibit 11B hydroxylase = low cortisol/aldosterone
