Adrenal Drugs Flashcards
What is another name for ACTH?
Corticotropin
What are the different zone in the adrenal cortex? What do these zones make?
Zona Glomerulosa- mineralcorticoids
Zona fasciculata- glucocorticoids
Zona reticularis- sex hormones/androgens
What zone of the adrenal cortex does ACTH work on? What does it cause
Zona fasciculata
Increase release of Cortisol
Increase hypertrophy of adrenal cortex
What is the process of increasing cortisol?
Hypo releases CRH which goes to anterior pituitary gland….which releases ACTH which goes to zona fasciculata…which releases cortisol
What factors increase CRH?
Low BG
Sleep wake cycle
Stress
What time of day is ACTH highest?
Morning
What is betamethasone?
Glucocorticoid
What is cortisone?
Glucocorticoid
What is dexamethasone?
Glucocorticoid
What is hydrocortisone?
Glucocorticoid
What is methylprednisolone? Route? What formulation is it available in?
Glucocorticoid
SC
IV
Intra-articular/sonovial
Available in long-acting (depot)
What is prednisone? Route commonly given at what time? Indication?
Glucocorticoid
PO
Morning to prevent insomnia
Respiratory illness
What is prednisolone?
Glucocorticoid
What is triamcinolone?
Glucocorticoid
What is aldosterone?
Mineralocorticoid
What is fludrocortisone? What activity does this type of corticosteroid have?
Mineralocorticoids
Aldosterone
Fludrocortisone
What do corticosteroid drugs end in?
-one and -ide
What routes do glucocorticoids come in?
Topical
PO
Inhaled
Nasal
What is glucocorticoid 4 MOA?
Gluconeogenesis
Protein wasting
Retain Na and H2O
Inhibits PLA2
What are indications for glucocorticoids(7)?
Inflammatory conditions Autoimmune disorders Allergic conditions Surfactant production Organ rejection Rashes Addison’s disease
What are inflammatory conditions that Tx glucocorticoid?
UC
Shock
Head trauma
Why are glucocorticoids used to Tx shock and head trauma?
Keeps blood in blood vessels by decreasing histamine release
What are the autoimmune disorders that are Tx w/ glucocorticoids?
RA
MS
MG
What is Tx Addison’s disease?
Fludrocortisone
Hydrocortisone
What is Addison’s disease? Cause? Sx? Tx drugs?
Decreased mineralcorticoids and glucocorticoids
Autoimmunity
Dehydration
HoTN
Hyperpigmentation
Fludrocortisone
Hydrocortisone
What are the two drug categories of glucocorticoids?
Natural steroids
Synthetic steroids
What are the 3 differences of synthetic corticosteroids from natural corticosteroids?
More potent
Less Na+ retention
Longer acting
What is important to know about fludrocortisone (Florinef) and hydrocortisone?
Fludrocortisone: mineralcorticoid and a little glucocorticoid activity
Hydrocortisone: glucocorticoid with a little mineralcorticoid activity
What is the MOA of Glucocorticoids?
Decrease WBC activity
Decrease secretion of proinflammatory and vasoactive cytokines
Inhibits PLA2
What is the difference between Cushing’s syndrome and Cushings disease? ACTH levels? Cortisol levels?
Cushing disease: only caused by a pituitary adenoma
Increased ACTH
Increased Cortisol
Cushing syndrome: caused by anything that increases the release of cortisol and androgens
Decreased ACTH
Increased Cortisol
What are the Sx of a pt w/ Cushing syndrome? What are the Sx d/t?
Cortisol release
- DM
- moon face
- Buffalo hump
Androgen release
-Hirsutism
What is aminoglutethimide(Cytadren) indicated for? MOA? ADR?
Cushing’s syndrome Tx
Inhibits glucocorticoid synthesis in the zona fasciculata
Increases ALT and AST
Why do you not want to discontinue glucocorticoids abruptly? ADR?
Because the drug cortisol has been sending a negative feedback to ACTH, ACTH is very low and needs to be brought back up
Severe mental depression
Adrenal atrophy
Why is it important to taper off glucocorticoid when DC the drug?
Allows ACTH levels to taper back up to higher levels
How do mineralcorticoids effect Na/K channels?
Retain Na+ and waste K+ in the DCT
What type of pts do you want to be cautious giving a corticosteroid?
Ulcers CHF active infection DM Heart issues Child growth
What is the contraindication for corticosteroids? What can it cause? What risk category is it?
Pregnancy
Cleft palate
Category C drug
Why is giving a corticosteroid to a child who is growing a risk?
Because corticosteroids decrease the release of GH
