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Nonliner (Dose Dependent Pharmacokinetics) > Adrenal Disorders Zoebeck > Flashcards

Adrenal Disorders Zoebeck Flashcards

1
Q

What is the purpose of the adrenal medulla?

A

Responsible for catecholamine secretion

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2
Q

What does the Zona glomerulosa secrete?

A

Mineralocorticoids mainly aldosterone

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3
Q

What does the Zona fasciculata secrete?

A

Glucocorticoids mainly cortisol

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4
Q

What does the Zona reticularis secrete?

A

Androgens

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5
Q

Adrenal hormones all start with what hormone?

A

Cholesterol

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6
Q

What is the Mineralocorticoid effect?

A

Aldosterone is responsible for holding onto Na+ keeping it in the cell and kicking K+ out.

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7
Q

What is the purpose of Glucocorticoids

A
  1. Carbs metabolism
  2. Increase gluconeogenesis
  3. Increase Glycogen storage and synthesis
  4. Diminish glucose utilization
  5. Prevents growth hormone from being released, decreasing growth plate and skeletal growth
  6. Anti inflammatory action
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8
Q

What are the signs of someone that has excess glucocorticoids?

A
  1. Buffalo hump
  2. Moon facies
  3. Increase free fatty acids
    All is caused by fat redistribution
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9
Q

What is the anti inflammatory action of Glucocorticoids?

A
  1. Suppress T lymphocytes
  2. Suppress cytokines
  3. Prevents mediator release (prostaglandins, histamines, leukotrienes)
  4. Vasoconstrictions, which decreases cap. permeability
  5. Increase erythrocyte and platelet concentration
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10
Q

When is the anti inflammatory property of glucocorticoid useful?

A

Organ transplant

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11
Q

What are some cardiovascular effects of glucocorticoids?

A

Increased risk for hypertension, stroke

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12
Q

What are the bone effects of glucocorticoids?

A

Decrease osteoblast
increase osteoclast, increasing bone turn over. This is important in child growth
Decreases the intestinal absorption of calcium

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13
Q

What happens to your muscles if you have exccess cortisol?

A

muscle wasting

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14
Q

What happens to your muscles if you have cortisol deficiency?

A

weakness and fatigue

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15
Q

What are the effects of cortisol on wound healing?

A

It decreases wound healing because it decreases fibroblast which is responsible for making collagen.

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16
Q

What are the effects of cortisol on the CNS?

A

Increases excitability, get tremors

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17
Q

Does cortisol level spike with meals?

A

yes

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18
Q

How does surgery affect cortisol levels?

A

Minor x2 increase

major x4 increase

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19
Q

What form of cortisol is active?

A

Free cortisol

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20
Q

What is involved in increased cortisol secretion

A
  1. Exercise
  2. Physical stress
  3. Anxiety/depression
  4. Anorexia nervosa
  5. Alcoholism
  6. Chronic renal failure
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21
Q

What is involved in decreased cortisol secretion?

A
  1. Estrogen
  2. Pregnancy
  3. Hypothyroidism
  4. DM
  5. Congenital
  6. Hematologic disorders
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22
Q

What does stimulate aldosterone do?

A
  1. Low BP

2. Lower sodium because it holds onto it

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23
Q

What does the inhibition of aldosterone do?

A
  1. Excess sodium

2. High blood pressure

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24
Q

What is Cushing syndrome?

A

hypercortisolism

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25
Q

What are the symptoms of Cushing syndrome?

A
  1. Moon facies
  2. Buffalo hump
  3. hypertension
  4. Central obesity
  5. Fatigue
  6. Glucose intolerance
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26
Q

What are the symptoms of Cushing if it were excess ACTH?

A

hyperpigmentation

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27
Q

What are the symptoms of Cushing if it were excess androgen?

A

Ance, hirsutism, alopecia, amenorrhea

28
Q

What are the non-pharmacologic therapies for Cushing syndrome?

A
  1. Surgery
  2. Radiation
  3. Bilateral adrenalectomy
    - glucocorticoid and mineralocorticoid replacement
29
Q

What is the preferred pharmacological treatment for Cushing syndrome?

A

Adrenal Enzyme inhibitors

30
Q

What is the problem with adrenal enzyme inhibitors?

A

Takes months to see efficacy

31
Q

What are the drugs to treat Cushing Syndrome?

A
  1. Ketoconazole
32
Q

What is the MOA of ketoconazole?

A
  1. Inhibits the synthesize of steroids - aldosterone, cortisol and testosterone
33
Q

What is the dose of Ketoconazole

A

600-800 mg /day

34
Q

What are the drug interactions with ketoconazole

A
  1. 3A4s, 2c9, and P-gp inhibitors
35
Q

What are the side effects of ketoconazole?

A

liver toxicity

36
Q

What can be used in combination with ketoconzaole?

A

Metyrapone

37
Q

What is the MOA of Metyrapone?

A

It inhibits the final step of cortisol synthesis (steroid 11 beta-hydroxylase)

38
Q

What is the dose of Metyrapone?

A

750-1000 mg, and 2grams max

39
Q

What are the side effects of Metyrapone

A

leukopenia, edema, ance, ligtheadedness

40
Q

What is mitotane?

A

Adrenal Enzyme Inhibitor

41
Q

What is the MOA of Mitotane?

A

inhibits the synthesis of cortisol, and androgen and low doses and destroys the adrenal gland at high doses

42
Q

What are the doses for Mitotane?

A
  1. Low - 1-3g/day

2. High- 1-6 g/day then titrate to 10 g/day

43
Q

What is Pasireotide?

A

A medication for Cushing Syndrome . It is an ACTH secretion inhibitor.

44
Q

What is the MOA of pasireotide?

A

inhibits the secretion of ACTH by activating somatostatin receptors on adenomas

45
Q

What is the dosing range of Pasireotide?

A

600-900 mcg subcutaneous BID

46
Q

What is Conn’s Syndrome?

A

Hyperaldosterone

47
Q

What is the cause of Conn’s Syndrome?

A
  1. Adrenal adenoma

2. Ideopathic

48
Q

What are the symptoms of Conn’s Syndrome?

A
  1. Hypertension
  2. Hypokalemia (muscle weakness, fatigue
  3. High levels of aldosterone vs. renin
49
Q

What are the treatments for Conn’s syndrome?

A
  1. Surgery
  2. aldosterone antagonist
  3. combination
50
Q

What is a treatment for Conn’s syndrome?

A
  1. Spironolactone

2. Eplernone

51
Q

What is the MOA of Spironolactone?

A

mineralcorticoid recepotor blocker s

aldosterone and testosterone inhibitor

52
Q

What is the dose of Spironolactone?

A

100-400mg/day

53
Q

What is the side effect of Spironolactone?

A

irregular period
skin rashes
Hyperkalemia
gynecomastia-man boobs

54
Q

How is Eplerenone different from Spironolactone?

A

specific antagonist on the mineralocorticoid receptor s

55
Q

What is Addison’s SYNDROME?

A

Can’t make aldosterone or cortisol or both

56
Q

What causes Addison’s syndrome?

A
  1. Primary (Addison’s Disease)
    - AI
    - Can’t make aldosterone AND cortisol
  2. Secondary (rare)
    - can’t make cortisol
    - tumors
57
Q

What are the signs of adrenal insufficiency?

A
  1. Weakness
  2. Black gums and pigmentation of skin
  3. Weight lost
58
Q

What can the modification of the chemical structure of glucocorticoids lead to?

A
  1. Different potency
  2. Different duration of action
  3. effects on electrolytes at high doses
  4. Different formulations
59
Q

What are the short acting steroids?

A
  1. Cortisone

2. Hydrocortisone

60
Q

What are the intermediate acting steroids?

A
  1. Prenisone
  2. Triamicinolone
  3. Methylprednisone
61
Q

What are the long acting steroids?

A
  1. Dexamethasone and Betamethasone
62
Q

What steroids are used for BOTH cortisol and aldosterone replacement?

A
  1. Hydrocortisone
  2. Cortisone
  3. Prednisone
    All the others are cortisol replacements
63
Q

what is Fludrocortisone acetate?

A

A potent synthetic aldosterone replacement..

64
Q

When using mineralcorticoid replacement what should you monitor?

A
  1. BP
  2. Sodium and Potassium
  3. Peripheral Edema
65
Q

What is Acute adrenal insufficiency?

A

An endocrine emergency
your body is shutting down because not enough cortisol
adrenal insufficiency

66
Q

What are the symptoms of acute adrenal insufficiency

A
  1. Fever
  2. Hypotension (low BP)
  3. shock
  4. Flu-fatigue, nausea
67
Q

What is the therapy for acute adrenal insufficiency?

A
  1. 100mg hydrocortisone stat q6-8hours taper

2. fluids

Nonliner (Dose Dependent Pharmacokinetics) (4 decks)

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