Adrenal Pharmacology Flashcards
What is used to treat adrenal insufficiency?
Glucocorticoids
How do synthetic glucocorticoids compare to natural as far as metabolism? Potency? Protein bound?
Metabolism: Slower
Potency: Increased
Protein bound: Less
What is the strength of synthetic glucocorticoids in decreasing potency?
Dexamethasone Betamethasone Fludrocortisone Methylprednisone Prednisolone Prednisone
Which is the strongest mineralocorticoid? Which has virtually no effect?
Strongest: Fludrocortisone
No effect: Dexamethasone
Which is the inactive form of cortisol? Chemically, how does it get to that state?
Cortisone, gets reduced
What is the best thing to give for acute adrenal insufficiency?
I.V. Cortisol
What is the best thing to give for chronic primary adrenal insufficiency?
Cortisol
Fludrocortisone if needed
What is the best thing to give for secondary adrenal insufficiency?
Cortisol
What is the best thing to give for partial or complete 21 hydroxylase deficiency?
Cortisol
Fludrocortisone
What are major side effects of glucocorticoid treatments?
Hyperglycemia Infection Ulcer Myopathy Osteoporosis HTN, K loss
What candy can augment cortisol effects?
Licorice
What is the method of administration for ACTH?
Injection
How is ACTH useful in testing adrenal insufficiency?
Distinguishes 1° from 2° adrenal insufficiency
How is ACTH useful in cisplatin treatment?
Anticonvulsant for infantile spasms and to prevent neurotoxicity of cisplatin
What is ACTH toxicity like?
Increased glucocorticoid effects
What can you do to treat Cushing disease for those who are poor surgical candidates?
Radiation
What drugs can suppress ACTH secretion?
Pasireotide (SST analog)
Cabergoline (D2 analog)
How does ketoconazole help cushing disease?
Blocks glucocorticoid synthesis by inhibiting side chain cleavage
How does aminoglutethimide help cushing disease?
Inhibits side chain cleavage enzyme
How does Etomidate help cushing disease?
Inhibits 11 beta hydroxylase
How does Metyrapone treat Cushing disease?
inhibits 11 beta hydroxylase in adrenal gland
What is mifepristone?
Synthetic steroid that acts as an antiprogestin.
High doses: binds strong to glucocorticoid receptors and some androgen receptors
What is mitotane?
DDT insecticide with adrenal toxicity
