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Pharmacology > Adrenal Cortex > Flashcards

Adrenal Cortex Flashcards

1
Q

Secretion of salt-retaining aldosterone is under the influence of what?

A

Angiotensin II

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2
Q

Steroid molecules from the adrenal glands are controlled by what?

A

Corticotropin (ACTH)

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3
Q

Which binding protein is 90% of cortisol bound to?

What protein is synthetic cortisteroids (dexamethasone) bound to?

A

Corticosteroid-binding globulin (CBG)

Albumin

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4
Q

Actions of glucocorticoids are most apparent when?

A

In the fasting state where they maintain an adequate glucose supply to the brain

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5
Q

How does glucocorticoids (cortisol) maintain glucose levels?

A

supply of glucose from gluconeogenesis

release of amino acids from muscle catabolism

inhibition of peripheral glucose uptake

stimulation of lipolysis

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6
Q

Half life of Cortisol?

A

60-90 minutes

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7
Q

How can the half life of Cortisol be extended?

A
  1. Pharmaceutical hydrocortisone given in large amounts

2. Stress, hypothyroidism, liver disease

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8
Q

How is cortisol metabolized and excreted

A

Metabolized in the liver

Excreted in the urine

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9
Q

What is another name for Acute Adrenocorticol Insufficiency:

A

Adrenal Crisis

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10
Q

What is the Adrenal Crisis?

A

Emergency state due to insufficient cortisol

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11
Q

Signs and Symptoms seen in Adrenocortical Insufficiency?

A

Weakness, abdominal pain, fever, confusion, N/V/D

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12
Q

What test can be used to asses Adrenocortical Insufficiency?

A

Cosyntropin- when given a postive test will be the inability to stimulate an increase in cortisol by 20 mcg/ml or more

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13
Q

Treatment for Adrenocortical Insufficiency: Adrenal Crisis

A

Hydrocortisone every 6-8 hrs

Fludrocortisone acetate (given as IV Hydrocortisone dose is decrease)

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14
Q

What is a side effect of giving Fludrocortisone acetate?

A

Edema

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15
Q

What are the Oral doses needed for Hydrocortisone vs Prednisone?

A

Hyrdorcortisone = 20mg
Prednisone = 5 mg
-making prednisone more potent

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16
Q

What dose of Dexamethasone and Fludorcortisone are needed to have the same effect of Hyrdrocortisone 20mcg

A

Dexamethasone = 0.75

Fludrocortisone 2

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17
Q

Most potent long acting glucocorticoid?

A

Betamethasone 0.6 mg

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18
Q

When are cortisol levels most highest? How much is released daily?

A

Early morning hours and after meals due to governed pules of ACTH

10-20 mg/d

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19
Q

What is another name for Chronic Adrenocortical Insufficiency?

A

Addison’s disease

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20
Q

What is a Chronic Adrenocortical Insufficiency?

A

Dysfunction or absence of the adrenal cortices

21
Q

Signs and symptoms of Addison’s Disease?

A 
Skin pigmentation
Hypotension
Small heart
Hyponatremia
Elevated K+, Ca++, BUN
22
Q

How is Addison’s Disease treated?

A

Hydrocortisone +/- Fludrocortison

23
Q

What is the drug of choice for treating Addison’s disease how should it be taken?

A

Hydrocortisone

2/3 of dose is given in the am
1/3 given in late afternoon

24
Q

What will cause an increase in dosing with Fludrocortsone acetate

A

Postural hypotension
Hyponatremia
Hyperkalemia
Fatigue

25
Q

What will cause a decrease in dosing with Fludrocortisone

A

Edema
Hypokalemia
HYPERtension

26
Q

What is side effect while taking Fludrocortisone that might be concerning for a Hypertensive patient

A

Sodium retaining effect

27
Q

What disease is DeHydroEpiAndrosterone (DHEA) used to treat?

A

Addison’s Disease

28
Q

What effect does taking DHEA have?

A

Improved sense of well-being
Increased muscle mass
Reversal of bone loss at the femoral neck

29
Q

What must be monitored while taking DHEA?

A

Monitor older women for androngenic effects

30
Q

Treatment for Addison Crisis?

A

Agressive IV saline, glucose, gluccorticoids

31
Q

What is another term for Hypercortisolism?

A

Cushing’s Syndrome

32
Q

What is the MC of Cushing’s Syndrome

A

exogenously administered drug

33
Q

How is Cushing’s disease caused?

A

Hypersecretion of ACTH hypersecretion by the anterior pituitary

34
Q

Who is Cushing’s syndrome most common in?

What other drug when taking in excess can cause Cushing’s?

A

Women

Excessive ingestion of Gamma Hydroxybutryric acid

35
Q

Signs Cushing’s Syndrome?

A 
Central obesity, muscle wasting
Moon face
Buffalo hump
Abdominal striae 
Thin skin
Bruisability 
Hypertension
36
Q

What is the best treatment of Cushing’s sydrome caused by pituitary adenoma?

What about pharmaceutical treatments?

A

Transphenoidal resection

6-36 months of corticosteroids until pituitary normalizes

37
Q

Treatment options for Ectopic ACTH syndrome

A

Metyrapone

Ketoconazole

38
Q

Treatment options for Pituitary dependent Cushing’s syndrome?

A 
Mitotane
Metyrapone 
Mifepristone
Cabergoline
Pasireotide
39
Q

Treatment options for Cushing’s caused by Adrenal adenoma

A

Ketoconazole

40
Q

Cushings caused by Adrenal carcinoma

A

Mitotane

41
Q

How is Hyperaldosteronism caused?

A

Excess aldosterone secretion or low levels of Ang II

42
Q

What are the causes of Primary Hyperaldosteronism?

A

Aldosterone-producing adenoma (APA)

Disorders of adrenal steroid biosynthesis with inherent mineralcorticoid activity

43
Q

What is another name for Hyperaldosteronism

A

Conn’s syndrome

44
Q

Causes of Secondary Hyperaldosteronism

A

Low levels of plasma renin activity and angiotensin

45
Q

Symptoms of Hyperaldosteronism

A

Hypertension with hypokalemia or resistant hypertension

Tetany/paralysis

Polydipsia/nocturnal polyuria

46
Q

Medications used to treat Hyperaldosteronism?

A

Amiloride
Eplerenone
Spirinolactone

47
Q

Which test is used to test for Cushings syndrome?

A

Dexamethasone suppression test

Dexamethasone 1 mg is given orally at 11 PM and serum is collected for cortisol determination at 8 AM the next morning

48
Q

What conformation test is used after patients have an abnormal dexamethasone suppression test?

A

24 hour urinary free cortisol and creatinine

Pharmacology (12 decks)

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