Adrenal Gland Pharmacology Flashcards
Same compound as the primary human circulating glucocorticoid:
A) Hydrocortisone B) Dexamethasone C) Fludrocortisone D) Ketoconazole E) Spironolactone F) Mifepristone
A – hydrocortisone is the same thing as cortisol, which is the most abundant circulating glucocorticoid in normal humans
Can be used as a potassium-sparing diuretic: A) Hydrocortisone B) Dexamethasone C) Fludrocortisone D) Ketoconazole E) Spironolactone F) Mifepristone
E
May cause gynecomastia due to acting as an antagonist at androgen receptors: A) Hydrocortisone B) Dexamethasone C) Fludrocortisone D) Ketoconazole E) Spironolactone F) Mifepristone
E
Progesterone receptor antagonist: A) Hydrocortisone B) Dexamethasone C) Fludrocortisone D) Ketoconazole E) Spironolactone F) Mifepristone
F
Glucocorticoid receptor antagonist: A) Hydrocortisone B) Dexamethasone C) Fludrocortisone D) Ketoconazole E) Spironolactone F) Mifepristone
F
Could be effective to block cortisol production in Cushing’s disease: A) Hydrocortisone B) Dexamethasone C) Fludrocortisone D) Ketoconazole E) Spironolactone F) Mifepristone
D
Primarily has mineralocorticoid activity: A) Hydrocortisone B) Dexamethasone C) Fludrocortisone D) Ketoconazole E) Spironolactone F) Mifepristone
C
Glucocorticoid agonist with little or no mineralocorticoid activity: A) Hydrocortisone B) Dexamethasone C) Fludrocortisone D) Ketoconazole E) Spironolactone F) Mifepristone
B
Which of the following statements most accurately describes why abrupt withdrawal from chronic
glucocorticoid therapy is such a serious problem?
A) The drugs have a very short half-life, and thus withdrawal quickly precipitates a problem
B) Exogenous glucocorticoid suppresses ACTH secretion resulting in adrenal atrophy
C) Exogenous glucocorticoids inhibit the enzymes necessary for endogenous hormone synthesis
B Exogenous glucocorticoids (that is, drugs/hormones that come from outside the body) feedback- inhibit the hypothalamic/pituitary/adrenal axis the same way that hormones produced in the body do. Thus, longterm, chronic glucocorticoid administration suppresses ACTH secretion. Because the adrenal glands require ACTH stimulation to remain viable and functional, they atrophy during sustained glucocorticoid exposure. When the hormone is abruptly withdrawn, ACTH levels will go back up, but it takes a while for the adrenals to respond to the ACTH and recover their functionality to produce hormone. Meanwhile, the lack of circulating glucocorticoid may create a lethal situation because of the important role that the glucocorticoids play in keeping key protein synthesis going in various tissues throughout the body (e. g. the production of hormones and receptors that are important for many functions).
A 42-year-old woman complains that she seems to be getting “fat” even though she’s been going to the gym lately. She is particularly worried about her face and the trunk of her body getting fat. She also reports that her hair is getting thinner and she feels lethargic. Blood levels of cortisol are found to be high.
Which of the following conditions is this woman most likely at risk of developing if her condition goes on untreated? A) Autoimmune disease B) Osteoporosis C) Hypovolemia D) Addison’s disease E) Acromegaly
B
This vignette describes a person with Cushing’s disease. Some of the symptoms at first might look like hypothyroidism, but there are several differences. The movement of fat from the limbs to the trunk is particularly symptomatic of hypercortisolism (as is the fact that the blood levels of cortisol are high!). Of the answer choices, only osteoporosis would be at high risk of developing in someone with Cushing’s disease (or Cushing’s syndrome in someone taking a glucocorticoid as a drug).
A 42-year-old woman complains that she seems to be getting “fat” even though she’s been going to the gym lately. She is particularly worried about her face and the trunk of her body getting fat. She also reports that her hair is getting thinner and she feels lethargic. Blood levels of cortisol are found to be high.
Which of the following pairs of drugs is most likely to help control this woman’s symptoms?
A) Mifepristone and spironolactone
B) Dexamethasone and ketoconazole
C) Dexamethasone and teriparatide
D) Ketoconazole and mifepristone
E) Spironolactone and mifepristone
D
Ketoconazole would decrease the synthesis of cortisol, and mifepristone would act as a receptor antagonist to block the action of hormone that did get made if the ketoconazole was unable to fully control the disease (ie, if it couldn’t reduce synthesis enough to get hormone levels into the normal range). Obviously you don’t want to totally eliminate circulating cortisol. The goal is to get it into the normal range. Similarly, you do not want to totally block cortisol activity with mifepristone.
T or F: Spironolactone will decrease the urinary concentration of potassium.
TRUE
Spironolactone ultimately prevents movement of potassium into the urine, retaining it in the blood; this is where the term “potassium-sparing” comes from, meaning that potassium is retained in the body
T or F: Spironolactone competes with aldosterone for binding to mineralocorticoid receptors.
TRUE
T or F: Mineralocorticoid receptors are ligand-activated transcription factors.
TRUE
Mineralocorticoid receptors are intracellular receptors that when activated by aldosterone or other agonists regulate gene transcription in a manner similar to the mechanism used by the thyroid hormone receptors, vitamin D receptors, glucocorticoid receptors, estrogen receptors, etc.
