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Endocrinology > Adrenal Pharm > Flashcards

Adrenal Pharm Flashcards

1
Q

Causes of Hyperaldosteronism (5)

A

Primary hyperaldosteornism
Secondary: Cirrhosis, heart failure
Liddle’s syndrome: mutation in epithelial sodium channel
Deoxycorticosone mediated
Licorice ingestion (pseudohyperaldosteronism)

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2
Q

Spionolactone: Action (3)

A

Mineralocorticoid antagonist

Also blocks androgen, progesterone receptors

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3
Q

Spriconolactone: Uses (3)

A

Potassium sparing diuretic (HTN, CHF, cirrhosis, nephrosis)
Primary hyperaldosteronism
PCOS/hirsutism

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4
Q

Spironolactone: AE (5)

A 
Hyperkalemia
Volume depletion
Gynecomastia/impaired libido in men
Menstrual irregularities
Teratogenic
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5
Q

Spironolactone: CI (3)

A

Renal impairment
Hyperkalemia
Pregnancy

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6
Q

What is action of eplerenone?

A

Highly selective mineralocorticoid antagonist

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7
Q

Eplerenone: uses (2)

A

Potassium sparing diuretic

Primary hyperaldosteronism

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8
Q

Eplerenone: CI (3)

A

Renal impairment
Hyperkalemia
Pregnancy

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9
Q

Amiloride: Action

A

Potassium sparing diuretic

Weak diuretic and weak antihypertensive

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10
Q

Amiloride: Use

A

potassium sparing diuretic

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11
Q

Amiloride: CI (2)

A

Renal impairment

Hyperkalemia

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12
Q

What things need to be monitored with potassium sparing mineralocorticoid antagonists? (4)

A

Dehydration
BP
Serum electrolytes
Men: gynecomastia

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13
Q

Mineralocorticoid deficiency: Causes (2)

A

Primary adrenal insufficiency

Hyporeninemia (i.e in diabetic nephropathy)

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14
Q

Mineralocorticoid deficiency treatment

A

Mineralocorticoid replacement: fludrocortisone (florinef)

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15
Q

What are side effects of fludrocortisone? (4)

A

Hypokalemia

Volume overload: edema, HTN, CHF

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16
Q

Monitoring fludrocortisone replacement: What are your concerns? (5)

A 
Presyncope, lightheadedness
Salt cravings
Swelling/edema
BP/HR
Monitor Na/K and plasma renin activity
17
Q

Hypercortisolism: Treatment options (5)

A

Surgical adrenalectomy or hypophysectomy
Mifepristone: glucocorticoid receptor antagonist
Mitotane: Adrenal cytotoxic
Inhibit enyzymes in steroidogenesis: Metyrapone, ketoconazole, aminoglutethimide
Inhibit ACTH secretion: Pasireotide (SS analog)

18
Q

Why does pasireotide work for Cushing’s syndrome?

A

Pituitary adenomas express somatostatin and dopamine receptors…pasireotide is SS analog and suppresses ACTH secretion

19
Q

What are side effects of SS analogs? (3)

A

Increase in blood glucose levels
Cardiac conduction defects
Gallstones

20
Q

How do adrenal enzyme inhibitors work?

A

Block steroid synthesis at multiple sites

21
Q

Why can’t you check urinary free cortisol in mifepristone treatment?

A

Because it blocks GCR, but doesn’t affect cortisol production

22
Q

For which treatments should you monitor LFTs?

A

Ketoconazole, pasireotide

23
Q

What are treatments for glucocrticoid deficiency? (3)

A

Cortisol replacement:
Hydrocortisone (half life=8-12hr)
Dexamethasone (half life=36-54hr)
Presdnisone (18-36hr)

24
Q

Why would you use hydrocortisone over other glucocorticoids?

A

Best approximates circadian rhythm

25
Q

What are principles of hydrocortisone treatment? (3)

A

Sick day replacement: double or triple daily dose for days with fever
Stress dose replacement: taper to physiologic dose once stress is relieved
Acute dose for shock/adrenal crisis: Use IV then taper to pays dose

26
Q

What is concern with high doses of hydrocortisone treatment?

A

It will overwhelm cortisol-cortisone shunt and bind mineralocorticoid receptor–>pseudohyperaldosternism

27
Q

What do we monitor for hydrocortisone replacement? (4)

A

Fatigue/appetite
BP, weight
Signs of over-replacement (iatrogenic Cushing’s)

28
Q

Testing for Primary Adrenal Insufficiency

A

First check morning cortisol

If low cortisol, do IM cosyntropin stimulation test

29
Q

Testing for Secondary Adrenal Insufficiency

A

Meyrapone testing:
If observe high levels of 11-deoxycortisol (cortisol precursor) then there is no secondary adrenal insufficiency
If low levels of 11-DOC, then pituitary problem

30
Q

What is enzyme that meyrapone blocks?

A

11-ß-hydroxylase

31
Q

Monitoring in metyrapone stimulation

A

Need inpatient monitoring, especially of BP/HR (concern is hypotension)
Terminate test with IV hydrocortisone to restore cortisol levels

32
Q

Use of synthetic glucocorticoids: Which ones do not affect mineralocorticoid receptors (3)

A

Methyl-prednisone
Triamcinolone (topical/inhaled)
Dexamethasone

33
Q

Main side effect for synthetic glucocorticoid

A

IATROGENIC CUSHING’S ALL DAY

Endocrinology (26 decks)

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