Adrenal Drugs Flashcards
What is Cosynotropin and what is it given for?
It is a synthetic ACTH, used in testing the function of the HPA axis (CRH - ACTH - Cortisol); Test is performed by measuring cortisol, then giving ACTH IV/IM, then measuring cortisol again in an hour.
What is the difference between Natural ACTH and Cosynotropin?
ACTH is made from animal glands and may contain a high level of vasopressin, Cosynotropin has less vasopressin (ADH)
Describe the interaction between Cortisol and Aldosterone, specifically in the kidney.
Cortisol has greater affinity than aldosterone for MC receptors. To handle this, Kidney has 11-B-hydroxysteroid dehydrogenase which converts cortisol –> cortisone which deosnt act on MC R;s (11BHDH overcome in cushings)
What is the MOA of Corticosteroids?
Bind cytosolic glucocorticoid receptors and translocate to nucleus, modify transcription of inflammatory genes. Inhibit NF-kb, AP-1, NFAT which decrease inflammatory cytokine (TNF-a, IL-1, and IL-6), Also decrease LT’s and PG’s through decreased Phospholipase A2 (decreased lipocortin)
How are corticosteroids administered?
Effective orally, absorbed from IM, conjunctiva, skin, and respiratory
How is cortisol transported in the blood?
90% protein bound transcortin and albumin
What are the general (not sex or age specific) ADEs of glucocorticoids?
Suppression of ACTH and TSH from pituitary (recovery can take > 1 yr = wean off), Osteoporosis, DM, peptic ulcers, CNS effects
What are the ADEs of GC’s in women?
in women it causes an ovulation, dysmenorrhea, uterine bleeding
What are the ADEs of GC’s in men?
In men it causes hypogonadism from decreased T
What are the ADEs of GC’s in kids?
in kids it causes decreased linear growth from inhibition of GH/IGF1
List the GC’s (Off the focus drug list) in order of least potency to highest potency
Hydrocortisone - same as cortisol Prednisone/Prednisolone - 4x potency Methylprednisone - 5x potency Betamethasone - 25-40x potency Dexamethasone - 30x potency
What GCs have mineralocorticoid effects?
The short acting ones, Pred (.3x), and Methyl (.5x)
What is Hydrocortisone used for?
Adrenal Insufficiency, Addisons, CAH, Skin dz, IBS
What is Prednisone/Prednisolone used for?
Addisons, Rheumatic Dz, Renal Dz, IBS, Liver DZ
What is Methylprednisone known to cause?
Allergic Symptoms
