Adrenal Pharmacology

Question 1

In order for corticosteroids to be released from the adrenal cortex, the hypothalamus releases _____, which stimulates the ant. pituitary to release _____, which stimulates the adrenal cortex.

Answer 1

CRF

ACTH

Question 2

Corticosteroids refers to?

Answer 2

Steroids made by the adrenal cortex -> mineralocorticoids and glucocorticoids

Question 3

Function of glucocorticoids?

Answer 3

metabolic, anti-inflammatory, and immunosuppressive

Question 4

Function of mineralocorticoids?

Answer 4

Peripheral actions on salt and water metabolism

Question 5

What are the zones of the adrenal cortex and what hormones does each produce?

Answer 5

Glomerulosa - Aldosterone
Fasiculata - Cortisol
Reticularis - DHEA

Question 6

Where do glucocorticoids provide negative feedback?

Answer 6

At the ant pituitary on ACTH release

At the hypothalamus on CRF release

Question 7

What hormone released by the zona fasiculata is a glucocorticoid?

Answer 7

Cortisol

Question 8

Chronic use of GCs can cause?

Answer 8

Adrenal atrophy due to suppression of the HPA axis.

Question 9

Insufficient adrenal response to environmental stressors known as adrenal crisis is treated with?

Answer 9

Supplemental GCs

Question 10

Secretion or cortisol peaks when?

Answer 10

Early AM and evening

Question 11

Cortisol in the blood is bound by _____.

Answer 11

Cortisol binding globulin (CBGs)

Question 12

T/F? Only free cortisol is active?

Answer 12

True

Question 13

T1/2 of cortisol?

Answer 13

60-90 minutes

Question 14

Cortisol actions on muscle cells?

Answer 14

Decrease glucose uptake
Increase protein breakdown
Overall - Muscle wasting

Question 15

Cortisol actions on fat cells?

Answer 15

Decrease glucose uptake
Increase fat breakdown peripherally.
Decrease fat breakdown centripetally.

Question 16

Cortisol actions on liver cells?

Answer 16

Gluconeogenesis leading to hyperglycemia

Question 17

Permissive effects of glucocorticoids?

Answer 17

Vasoconstrictor
Fat cell lipolytic response to epi, ACTH, GH
Normal cardiac output

Question 18

What hormone released by the adrenal cortex is a mineralocorticoid?

Answer 18

Aldosterone

Question 19

Effects of aldosterone?

Answer 19

Na+ reabsorption at kidney leading to increased blood volume and BP

Question 20

Excess aldosterone would cause what symptoms?

Answer 20

Hypertension, hypokalemia, metabolic alkalosis

Question 21

T/F? Anti-inflammatory effects of GCs can be separated from immunosuppressive effects.

Answer 21

False

Question 22

Addison’s disease is ____ adrenal insufficiency.

Answer 22

Primary

Question 23

Addison’s disease requires replacement of both GCs and MCs. What medications should be used to replace them?

Answer 23

Hydrocortisone or Prednisone Or Dexamethasone +/- fludrocortisone

Question 24

What medication is used for it’s anti-inflammatory/immunosuppressive properties without MC activity?

Answer 24

Dexamethasone

Question 25

Why must prednisone be given orally?

Answer 25

Gets metabolized to active form - prednisolone in the liver.

Question 26

``` Rank the following drugs from most to least anti-inflammatory potency. Dexamethasone Cortisol Fludrocortisone Prednisone Triamcinolone Aldosterone ```

Answer 26

``` Dexamethasone Fludrocortisone Triamcinolone Prednisone Cortisol Aldosterone ```

Question 27

Rank the following drugs from most to least salt-retaining potency. Cortisol Fludrocortisone Prednisone Aldosterone

Answer 27

Aldosterone Fludrocortisone Cortisol Prednisone

Question 28

What advantage do dexamethasone and prednisone have over hydrocortisone in the treatment of Addison's disease?

Answer 28

They are longer acting than hydrocortisone

Question 29

When would you add fludrocortisone to a patients treatment for Addison's

Answer 29

If they are hypotensive.

Question 30

T/F? DHEA can help with mood and well being in all patients with Addison's.

Answer 30

False - only in some women

Question 31

Treatment for adrenal crisis?

Answer 31

Volume replenishment Large amounts of IV hydrocortisone if pervious diagnosis Dexamethasone if no previous diagnosis

Question 32

Why does the treatment differ for patients with a previous diagnosis of Addison's?

Answer 32

Dexamethasone does not interfere with cortisol labs

Question 33

Cushing's disease is _____ hypercortisolism

Answer 33

Secondary

Question 34

Treatment of choice for Cushing's?

Answer 34

Surgery

Question 35

What types of medications can be used for adjunctive therapy or pharmacotherapy in inoperable cases of Cushing's?

Answer 35

Cortisol synthesis inhibitors GC receptor antagonists Somatostatin analogs

Question 36

What cortisol synthesis inhibitors are used early? late?

Answer 36

Early - ketoconazole | late - Metyrapone, etomidate

Question 37

What medication is a GC receptor antagonist?

Answer 37

Mifepristone (RU-486)

Question 38

What medication is a somatostatin analog that is used in Cushing's?

Answer 38

Pasireotide

Question 39

Is the dose of ketoconazole higher or lower in Cushing's when comparted to the antifungal dose?

Answer 39

Higher

Question 40

Adverse reactions to ketaconazole?

Answer 40

headache, n/v, gynecomastia, impotence, reversible hepatotoxicity.

Question 41

Adverse reactions to metyrapome?

Answer 41

Hirsutism in women, Na+ retention and HTN

Question 42

Congenital adrenal hyperplasia is treated with?

Answer 42

Cortisol +/- fludrocortisone

Question 43

Before surgery for a pheochromocytoma, what medications need to be given?

Answer 43

An alpha blocker - phenoxybenzamine (or terazosin/doxazosin) A beta blocker - Metoprolol (or labetalol) +/- nicardipine depending on BP

Question 44

If a pheochromocytoma is inoperable, what medication would be added?

Answer 44

Metyrosine (catecholamine synthesis inhibitor

Question 45

Treatment of choice for adrenomedullary hyperfunction?

Answer 45

Surgery