Adrenal Drugs

Question 1

Glucocorticoids (drugs 5, mechanism+effects, uses, side effects)

Answer 1

Drugs: hydrocortisone, cortisone, prednisone, prednisolone, dexamethasone

Mechanism: bind glucocorticoid receptor
Uses:
Side effects: Cushingoid effects- hyperglycemia/diabetes, fat redistribution to central obesity, catabolism (muscle wasting, osteoporosis, purple striation & bruising, poor wound healing, reduced growth). Also hirsutism, sweating, acne, depression/anxiety/hypomania, intraocular pressure/glaucoma/cataracts, peptic ulcers, infection, insomnia, HTN (if mineralocorticoid too like cortisol/cortisone)

Question 2

Mineralocorticoids

Answer 2

Fludricortisone

Question 3

Addison’s Disease treatment

Answer 3

-glucocorticoids + mineralocorticoids

Question 4

Congenital Adrenal Hyperplasia treatment

Answer 4

Prevents cortisol production, causing increased ACTH. Usually 21ß-hydroxylase issue so decreased gluco and mineralocorticoids, hyperandrogens
Treatment: glucocorticoids/mineralocorticoids

Question 5

Endogenous Cushing’s Syndrome treatment

Answer 5

• Ketoconazole/metyrapone (CYP inhibitor)
• mifepristone (GC receptor antagonist)
• Dopamine agonist (cabergoline)
• somatostatin receptor agonist (pasireotide) - latter 2 block ACTH release

Question 6

Conn syndrome treatment

Answer 6

-primary hyperaldosteronism caused by adrenal adenoma

Treatment: spironolactone + eplerenone

Question 7

Pheochromocytoma treatment

Answer 7

Treatment:

• å-agonist (phenoxybenzamine, prazosin/terazosin/doxazosin) preop
• ß-blockers (atenolol/metoprolol/propranolol)
• metyrosine (catecholamine biosynthesis inhibitor)

Question 8

Ketoconazole

Answer 8

Mechanism: CYP inhibitor preventing cortisol/aldosterone production
Use: Cushing’s syndrome/disease treatment
Side effects: GI, Hepatotoxicity

Question 9

Metyrapone

Answer 9

Mechanism: CYP inhibitor preventing cortisol/aldosterone production
Use: Cushing’s syndrome/disease treatment
Side effects: GI, bp/electrolytes, androgenic effects

Question 10

Mifepristone

Answer 10

Mechanism: GC receptor antagonist
Use: treat cushings
SE: menstrual abnormalities, nausea, fatigue, hypokalemia

Question 11

Cabergoline

Answer 11

Mechanism: Dopamine agonist, Suppresses pituitary ACTH
Use: Cushings
Side effects: cardiac valvulopathy, headaches, lightheadedness + orthostatic hypotension, fatigue, psych stuff

Question 12

Pasireotide

Answer 12

Mechanism: somatostatin receptor agonist
Use: cushings- suppresses ACTH release
SE: GI, hyperglycemia, bradycardia, conduction issues

Question 13

Spironolactone

Answer 13

Mechanism: MC receptor competitive inhibitor
Use: treats hyperaldosteronism
SE: hyperkalemia, cardiac arrhythmia, menstrual issues, gynecomastia

Question 14

Eplerenone

Answer 14

Mechanism: competitive inhibitor of MC receptors
Use: hyperaldosteronism
SE: hyperakalemia

Question 15

Phenoxybenzamine

Answer 15

Mechanism: selective å1 antagonist (irreversible)
Use: Pheochromocytoma HTN treatment preop
SE: orthostatic Hypotension, tachycardia

Question 16

Prazosin, Terazosin, Doxazosin

Answer 16

Mechanism: competitive å1-antagonist
Use: Pheochromocytoma HTN
SE: orthostatic hypotension

Question 17

Atenolol, metoprolol, propranolol

Answer 17

ß-blockers
Use: lower HR, bp, treat pheo with å-antagonists
SE: bradycardia, fatigue, cold hands

Question 18

Metyrosine

Answer 18

Mechanism: tyrosine hydroxylase competitive inhibitor (prevents catecholamine synthesis)
Use: treats pheo HTN
SE: orthostatic hypotension, crystalluria