Adrenal Pharmacology Flashcards
List 5 causes of hyperaldosteronism
- Primary hyperaldosteronism
- Secondary hyperaldosteronism (cirrhosis, heart failure)
- Liddle’s Syndrome (mut in epithelial Na channel, reabsorb Na)
- Deoxycorticosterone mediated (too many steroids, bind MCR receptor)
- Licorice ingestion (pseudohyperaldosteronism
What is Spironolactone?
Mineralocorticoid Receptor Antagonist (It also blocks androgen and progesterone receptors)
What is a side effect of Spironolactone?
- Hyperkalemia
- Vol depletion
- Gynecomastia, impaired libido (androgen binding)
- Menstrual irreg in women
- Teratogenic
Why do we use Spironolactone?
Potassium sparing diuretic for essential hypertension, congestive heart failure, cirrhosis, nephrosis and for primary hyperaldosteronism
Off label: PCOS/hirsuitism because of antagonistic binding to androgen receptors
What are the contraindications of Spironolactone?
Renal impairment
Hyperkalemia
Pregnancy
What is Eplerenone?
More specific mineralocorticoid receptor antag (but more expensive)
What do we use Eplerenone for?
K+ sparing diuretic
Primary hyperaldosteronism
What are the contraindications for Eplerenone?
Renal impairment
Hyperkalemia
Pregnancy
What is Amiloride?
Blocks the Na+ channel (ENaC)
Why do we use Amiloride?
K+ sparing diuretic, but it is weak since you still have high aldosterone binding which makes many Na+ channels
What are the contraindications of Amiloride?
Renal impariment, hyperkalemia
How do we monitor K+ sparing diuretics?
- Monitor for dehydration
- Monitor BP
- Monitor serum electrolytes (esp k+) and creatinine
- In men, monitor for gynecomastia with spironolactone
What are the 2 reasons to have a deficiency in mineralocorticoids?
- Primary adrenal insufficiency (loss of glucocorticoids and mineralocorticoids_
- Hyporeninemia (like someone wth diabetic nephropathy)
How do we treat mineralocorticoid deficiencies?
Mineralocorticoid replacements
What is fludrocortisone?
Is a synthetic mineralocorticoid replacement that acts like aldosterone used to control hyperkalemia and maintain intravascular volume
Side effects of fludrocortisone?
Hypokalemia
Volume overload leading to edema, hyperT, congestive heart failure