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1. Pharm II > Adrenal diseases > Flashcards

Adrenal diseases Flashcards

1
Q

Secretion of steroid molecules is controlled by what?

A

Pituitary release of corticotropin (ACTH)

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2
Q

Secretion of aldosterone is primarily under the influence of what?

A

angiotensin

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3
Q

What are the Physiologic effects of adrenal hormones?

A
  • regulation of intermediary metabolism
  • cardiovascular function
  • growth
  • immunity
  • synthesis & secretion tightly regulated by CNS
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4
Q

Corticosteroid-binding globulin (CBG) is increased in what and decreased in what?

A

Increased: pregnancy, estrogen administration, hyperthyroidism

Decreased: hypothyroidism, genetic defects in synthesis, protein deficiency states

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5
Q

What is the relationship between cortisol and catecholamines?

A

Response of vascular and bronchial smooth muscle to catecholamines = diminished in absence of cortisol

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6
Q

In the fasting state, what are the functions of glucocorticoids in order to supply the brain? (4)

A
  • supply glucose from gluconeogenesis
  • release amino acids from muscle catabolism
  • inhibition of peripheral glucose uptake
  • stimulation of lipolysis
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7
Q

What are some things that can increase the half-life of cortisol? (3)

A

stress
hypothyroidism
liver dz

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8
Q

Acute Adrenocortical insufficiency= ?

A

adrenal crisis

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9
Q

Chronic Adrenocortical Insufficiency= ?

A

Addision’s dz

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10
Q

Hypercortisolism = ?

A

Cushing’s syndrome

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11
Q

What happens in Adrenal crisis?

A

Emergency state due to insufficient cortisol

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12
Q

Signs/Sx of adrenal crisis (acute adrenocortical insufficiency)

A

Low BP
increased skin pigment
dehydration

weakness, abs pain fever, confusion, N/V/D

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13
Q

What are the expected results if a pt has acute adrenocortical insufficiency and you test them using Cosyntropin?

A

Cosyntopin unable to stimulate an increase in serum cortisol to > 20 mcg/ml

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14
Q

What are the first things you should use to treat an Adrenal crisis?

A

fluid replacement

vasopressors

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15
Q

If a pt is not responsive to fluid/pressors, what treatments do you give?

A
  • Hydrocortisone IV

- Fludrocortisone acetate orally added as IV hydrocortisone dose decreased

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16
Q

What kind of steroid is Fludrocortisone?

A

mineralcorticoid steroid

17
Q

What is a side effect of fludocortisone?

A

edema

18
Q

Hydrocortisone is what kind of steroid?

A

short/medium acting glucocorticoid

19
Q

Dexamethasone is what kind of steroid?

A

Long-acting glucocorticoid

20
Q

Prednisone is what kind of steroid?

A

short/medium acting glucocorticoid

21
Q

What are some signs and sx of Addison’s dz?

A
  • skin pigmentation
  • hypotension, small heart
  • low serum Na
  • Elevate K+, Ca++, BUN
22
Q

What is used to treat Addison’s dz?

A

combination corticosteroids and mineralcorticoids

corticosteroids alone if mild

23
Q

how is hydrocortisone dosed in Addison’s dz?

A

2/3 dose given in AM, 1/3 given in late afternoon

24
Q

What is the main ADE of Fludrocortisone acetate?

A

sodium retention

25
Q

When do you increase dose in Addison’s dz? (4)

A
  • postural hypotension
  • hyponatremia
  • hyperkalemia
  • fatigue
26
Q

when do you decrease dose in Addison’s dz? (3)

A
  • edema
  • hypokalemia
  • hypertension
27
Q

What is the function of DHEA in Addison’s dz? (3)

A
  • improved sense of well-being
  • increased muscle mass
  • reversal of bone loss at the femoral neck
28
Q

How do you treat an Addison Crisis?

A

Aggressive IV saline
glucose
glucocorticoids
tx underlying cause

29
Q

AEDs of prednisone

A
  • growth inhibition
  • muscle wasting
  • osteoporosis
  • salt retention
  • glucose intolerance
  • behavioral changes
30
Q

Causes of Hypercortisolism

A
  • exogenous administration of drug (MC)
  • ACTH hypersecretion (from anterior pituitary tumor)
  • ACTH-secreting neoplasms
31
Q

Signs and sx of Cushing’s syndrome

A

-central obesity
-hirsutism, purple striae
-psychological changes
-hyperglycemia
leukocytosis

32
Q

Drug tx options for Cushing’s syndrome caused by ectopic ACTH syndrome

A

Metyrapone

Ketoconazole

33
Q

Drug tx options for Cushing’s syndrome caused by adrenal adenoma

A

Ketoconazole

34
Q

Drug tx options for Cushing’s syndrome caused by adrenal carcinoma

A

Mitotane

35
Q

Drug tx options for Cushing’s syndrome that is pituitary-dependant

A 
Mitotane
Metyrapone
Mifepristone
Cabergoline
Pasireotide
36
Q

What the 2 causes of hyperaldosteronism? Which is primary and which is secondary?

A

Excess aldosterone secretion or low levels of angiotensin II

Primary= excess aldosterone
Secondary= low angiotensin II
37
Q

Sx of hyperaldosteronism

A
  • htn w/ hypokalemia or resistant htn
  • tetany/paralysis
  • polydipsia/nocturnal polyuria
38
Q

Drug tx options for hyperaldosteronism (3)

A

Amiloride
Eplerenone
Spironolactone

39
Q

What is the 1st test done for Cushing’s syndrome?

what is the confirmatory test?

A

1st/easiest= Dexamethasone suppression test

confirmatory= 24-hr urinary free cortisol and creatinine

1. Pharm II (11 decks)

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