Adrenal Corticoid Drugs

Question 1

glucocorticoid agonist

Answer 1

prednisone

Question 2

mineralocorticoid agonist

Answer 2

fludrocortison

Question 3

Glucocorticoid receptor antagonist

Answer 3

mifepristone

Question 4

mineralocorticoid receptor antagonist

Answer 4

spironolactone

Question 5

corticosteroid synthesis inhibitor

Answer 5

ketoconazole

Question 6

two therapeutic effects of corticosteroids

Answer 6

immunosuppression

anti-inflammatory

Question 7

Problems with chronic corticosteroid use

Answer 7

cannot be given chronically without the risk of adverse events (infection, osteoporosis, weight gain, cushingoid appearance, etc)

Question 8

Carbohydrate metabolism effects of glucocorticoids

Answer 8

• increased gluconeogenesis
• increased glucose output
• increased glycogen synthesis
• decreased glucose uptake –> development of hyperglycemia

Question 9

Problem with diabetics and glucocorticoid use

Answer 9

hyperglycemia! (maybe fix with pramlintide?)

Question 10

inhibitors of 11beta-HSD2 (2)

Answer 10

1) glycyrrhin (licorice root extract)

2) carbenoxolone

Question 11

11beta-HSD2 action

Answer 11

converts active steroids to inactive steroids

Question 12

result of inhibition of 11beta-HSD2

Answer 12

elevated blood pressure

Question 13

Mitotane use

Answer 13

can treat cancer of the adrenal glands (adrenal cortical carcinoma)

Question 14

short acting glucocorticoids (2) and duration of action

Answer 14

1) hydrocortisone (cortisol)
2) cortisone acetate
8 -12 hours

Question 15

intermediate acting glucocorticoids (4) and duration of action

Answer 15

1) prednisone
2) prednisolone
3) methylprednisolone
4) triamcinolone
12 - 36 hours

Question 16

long acting glucocorticoids (2) and duration of action

Answer 16

1) dexamethasone
2) betamethasone
36 to 72 hours

Question 17

pharmacokinetics of prednisolone

Answer 17

duration of activity is longer than pharmacokinetic 1/2 of drug owing to gene transcription effects

Question 18

Toxicities of prednisolone

Answer 18

adrenal suppression

Question 19

mifepristone clinical applications

Answer 19

medical abortion

Question 20

adverse effect mifepristone

Answer 20

vaginal bleeding in women

Question 21

clinical use fludrocortisone

Answer 21

adrenal insufficiency (addison’s disease)

Question 22

pharmacokinetics fludrocortisone

Answer 22

long duration of action

Question 23

spironolactone pharmacoinetics

Answer 23

slow onset and offset (duration 24-28 hours)

Question 24

adverse effects spironolactone

Answer 24

• hyperkalemia
• gynecomastia
• additive interaction with other K+ retaining drugs

Question 25

eplerenone clinical applications

Answer 25

indicated for the treatment of HTN, to lower blood pressure

Question 26

is gynecomastia a side effect of eplerenone?

Answer 26

no

Question 27

ketoconazole clinical applications

Answer 27

inhibits mammalian steroid hormone synthesis and fungal ergosterol synthesis

Question 28

drug interactions ketoconazole

Answer 28

many drug-drug CYP-450 interactions