Adrenal/Bone Pharm

Question 1

What are the 3 adrenocorticosteroids?

Answer 1

1-Glucocorticoids (regulation of intermediary metabolism/immunity)
2-Mineralcorticoids (aldosterone-salt retention)
3-Androgens (dehydroepiandrosterone-can be converted to estrogens)

Question 2

What drugs are used for their rapid and dramatic effect on inflammation and slows bone erosion and rheumatoid arthritis?

Answer 2

Glucocorticoids

*may cause loss of muscle mass and diabetogenesis

Question 3

What is the half-life of cortisol (hydrocortisone)?

Answer 3

60-90 minutes

*synthesized from cholesterol

Question 4

When plasma cortisol levels exceed ______ mug/dL CBG is saturated and the concentration of free cortisol rises rapidly

Answer 4

20-30

Question 5

Steroids interact with _______ to regulate and transcribe target genes

Answer 5

promoters

Question 6

What do glucocorticoids stimulate in the fasting state?

Answer 6

Gluconeogenesis and glycogen synthesis

Question 7

How do glucocorticoids affect fat deposits?

Answer 7

Has a net increase in fat deposition

Question 8

How do glucocorticoids affect bone?

Answer 8

They have catabolic and anti-anabolic effects on bone causing osteoporosis

*major limitation of long term steroid use

Question 9

How is inflammation reduces by glucocorticoids?

Answer 9

They affect leukocytes and suppress inflammatory cytokines/chemokines

Question 10

What are 3 short-medium acting glucocorticoids?

Answer 10

1-Hydrocortisone
2-Cortisone
3-Prednisone

Question 11

Which glucocorticoid is long-acting?

Answer 11

dexamethasone

Question 12

What are 7 conditions steroids can be used for?

Answer 12

1-Allergic rxns
2-GI disease
3-Systemic inflammation
4-Infection
5-Inflammatory conditions of bones/joints
6-Pulmonary disease
7-Skin disease

Question 13

Which disease is a result of adrenal glands producing too little cortisol, often has insufficient levels of aldosterone and may have weakness and weight loss?

Answer 13

Addison’s disease

Question 14

What is the typical treatment for Addison’s disease?

Answer 14

20-30 mg of hydrocortisone daily

*fludrocortisone may be added for salt-retention

Question 15

Which disease has chronic high levels of cortisol usually due to a ACTH secreting tumor?

Answer 15

Cushing syndrome

*fatty hump between shoulders, round face, stretch marks, osteoporosis and hypertension

Question 16

What are 3 cushings medications?

Answer 16

1-Ketoconazole (nizoral)
2-Metyrapone (Metopirone)
3-Mifepristone (korlym)

Question 17

Which drug is an inhibitor of adrenal and gonadal steroid synthesis by inhibiting side chain cleavage required for steroid hormone synthesis?

Answer 17

Ketoconazole (Nizoral)

Question 18

Which drug has a relatively selective inhibitor of steroid 11-hydroxylaiton and interferes with cortisol and corticosterone synthesis?

Answer 18

Metyrapone (Metopirone)

Question 19

Which drug is an antagonist to steroid receptors?

Answer 19

Mifepristone (Korlym)

Question 20

_______ Is abnormal loss of bone whereas ______ is uncontrolled osteoclastic bone resorption and poor bone formation

Answer 20

Osteoporosis

Paget’s disease

Question 21

What drug is secreted by thyroid, is 32 AA peptide, administered by injection or spray and inhibits osteoclastic bone resorption?

Answer 21

Calcitonin

Question 22

What are the three main regulators of Ca homeostasis?

Answer 22

1-Parathyroid Hormone (PTH)
2-Fibroblast growth factor 23 (FGF23)
3-Vit D

*Calcitonin is less critical

Question 23

Which group of drugs suppress activity of osteoclasts in part through the inhibition os farnesyl pyrophosphate synthesis?

Answer 23

Bisphophonates

*inhibit bone resorption. used to prevent osteoporosis and pagets disease

Question 24

What are the two main bisphosphonate drugs?

Answer 24

1-Ibandronate (Boniva)-monthly

2-Alendronate sodium (Fosamax)-daily/weekly

Question 25

What are 4 drugs that secondarily regulate bone mineral homeostasis?

Answer 25

1-Calcitonin
2-Glucocorticoids (reverse hypercalcemia)
3-Estrogens (prevent bone loss)
4-Selective estrogen Receptor Modulators

Question 26

Which drug is an antibody to the osteoclast stimulating RANK?

Answer 26

Denosumab (XGEVA)

*Blocks osteoclast number and activity

Question 27

Which drug is a recombinant form of parathormone segment and activates osteoblasts to stimulate new bone formation?

Answer 27

Terparatide (Forteo)