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DEMS Unit 3 > Adrenal Pharmacology > Flashcards

Adrenal Pharmacology Flashcards

1
Q

How do glucocorticoids mediate anti-inflammation? (Biochemical)

A

Glucocorticoids inhibit expression of COX-2 and Phospholipase A2 in inflammatory cells, leading to decreased prostaglandin and leukotriene formation

Also block activation of TH0 to TH1/TH2 and reduces release of cytokines from TH1/TH2

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2
Q

How do glucocorticoids mediate anti-inflammation? (Vascular)

A

Decreased vasodilation

Decreased fluid exudation

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3
Q

How do glucocorticoids mediate anti-inflammation? (Cellular)

A

Overall decrease in accumulation and activation of inflammatory cells in peripheral tissues

Decreased proliferation of blood vessels

Decreased fibrosis

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4
Q

11-hydroxy glucocorticoids - 5 agents

A 
Cortisol (hydrocortisone) 
Prednisolone
Methylprednisolone
Dexamethasone 
Fludrocortisone
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5
Q

11-keto glucocorticoids - 2 Agents

A

Prednisone
Cortisone

Must be activated by 11B-HSDI in the liver; this enzyme is not found in the skin so these drugs cannot be used as topicals

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6
Q

11B Hydroxysteroid Dehydrogenase I (11B-HSDI)

A

Hepatic enzyme that activates 11-keto glucocorticoids (Prednisone, Cortisone) to 11-hydroxy glucocorticoids

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7
Q

Cortisol (Hydrocortisone)

A

50% Glucocorticoid / 50% Mineralocorticoid activity

Preferred agent for physiological replacement, i.e. in Addison’s Disease

Can be administered orally, IV/IM, or topical

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8
Q

Prednisolone

A

Product of prednisone activation in the liver

4-5x more potent glucocorticoid activity than cortisol with less mineralocorticoid activity

Available oral, injectable; most commonly used oral agent for steroid burst therapy

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9
Q

Methylprednisolone

A

5-6x more potent glucocorticoid activity than cortisol with less mineralocorticoid activity

Oral, injectable

Often used for parenteral administration of steroid burst

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10
Q

Dexamethasone

A

Longest acting, highest potency glucocorticoid activity with essentially no mineralocorticoid activity

Used in cerebral edema, chemotherapy-induced vomiting

Available oral, injectabe, topical

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11
Q

Fludrocortisone

A

Addition of fluorine enhances mineralocorticoid activity; retains a low level of glucocorticoid activity

Available oral only

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12
Q

Addison’s Disease - Treatment

A

Cortisol - baseline dose must be increased 2-4x during periods of physiological stress

Fludrocortisone

+/- DHEA

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13
Q

Treatment of acute adrenal crisis

A

IV Cortisol until stable, then switch to lower oral maintenance doses of hydrocortisone and add fludrocortisone

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14
Q

Cushing’s Syndrome - Etiology

A

Pituitary tumor secreting excess ACTH - 70%

Non-pituitary tumor secreting excess ACTH (Ectopic Cushing’s, often small cell carcinoma) - 15%

Adrenal tumor secreting excess cortisol - 15%

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15
Q

Cushing Syndrome - Treatment

A
  1. Surgery to remove ACTH / ectopic / adrenal tumor

Ketoconazole - inhibits rate limiting conversion of cholesterol to pregnenolone in cortisol synthesis

Mifepristone - Glucocorticoid receptor antagonist

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16
Q

Mifepristone

A

Glucocorticoid receptor antagonist

Approved for control of hyperglycemia secondary to hypercortisolism

Can cause increased cortisol secretion via block of negative feedback at the pituitary

17
Q

21 hydroxylase deficiency

A

21 hydroxylase is necessary for both cortisol and aldosterone synthesis

Lack of cortisol synthesis leads to increased ACTH, causing adrenal hyperplasia and virilization via shunting of pregnenolone down the androgen synthesis pathway

Lack of aldosterone synthesis causes hypotension

18
Q

17-alpha hydroxylase deficiency

A

17a hydroxylase is necessary for both cortisol and adrenal androgen synthesis

Enzyme deficiency causes increased ACTH (adrenal hyperplasia) and increased mineralocorticoid synthesis, leading to hypertension

19
Q

11B-hydroxylase deficiency

A

11B-hydroxylase is required for cortisol synthesis

Enzyme deficiency causes increased ACTH (adrenal hyperplasia) with shunting of pregnenolone toward androgen production (virilization) and aldosterone production (hypertension)

20
Q

Pheochromocytoma - Special surgical considerations

A

Requires pharmacologic preparation with alpha-adrenergic receptor blockade to avoid hypertensive crisis, i.e. phenoxybenzamine

Selective beta blocker (metoprolol) given after adequate alpha-adrenergic receptor blockade to control tachycardia

+/- Calcium channel blockers (Nifedipine) if blood pressure control is inadequate

21
Q

Metyrosine - Mechanism & Uses

A

Competitive inhibitor of catecholamine synthesis

Reduces synthesis of catecholamines in inoperable or metastatic pheochromocytoma

22
Q

11B-hydroxysteroid dehydrogenase 2 (11B-HSD2)

A

Inactivates cortisol by conversion to cortisone in the kidney

23
Q

11B-hydroxysteroid dehydrogenase 1 (11B-HSD1)

A

Activates cortisone by conversion to cortisol in the liver

11B-HSD1 is inactive in fetuses; therefore, can treat pregnant women with betamethasone without effect on fetus

24
Q

Effects of epinephrine

A

Primarily binds beta-adrenergic receptors

B1 - Increased cardiac contractility, heart rate

B2 - Gluconeogenesis, lipolysis; smooth muscle dilation in muscule arterioles, GI/GU, and bronchial tree

25
Q

Effects of norepinephrine

A

Primarily binds alpha-adrenergic receptors (Alpha-1)

Increased gluconeogenesis, glycogenolysis, lipolysis
Arteriolar vasoconstriction, hypertension
Smooth muscle contraction - GI/GU
CNS - Dilation of pupils, arousal

26
Q

Autoimmune Polyendocrine Syndrome 1 (APS-1)

A

Addison’s
Hypoparathyroidism
T1DM
Mucucutaneous Candidiasis

27
Q

Autoimmune Polyendocrine Syndrome 2 (APS-2)

A

Addison’s
Hypothyroidism
T1DM

28
Q

MEN2A

A

Pheochromocytoma
Medullary thyroid carcinoma
Hyperparathyroidism

29
Q

MEN2B

A

Pheochromocytoma
Medullary thyroid carcinoma
Mucosal neuromas

30
Q

Phenoxybenzamine

A

Alpha blocker - used to pre-operatively lower BP in pheochromocytoma patients

Lower BP may cause reflex tachycardia, which can be treated with Beta Blockers; however, BBs must be given only after alpha blockers to avoid unopposed alpha-agonism and hypertensive crisis

31
Q

MEN1

A

Pituitary Adenoma
Parathyroid adenoma / hyperplasia
Pancreatic endocrine neoplasm

DEMS Unit 3 (7 decks)

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