Adrenal Pharmacology

Question 1

3 Treatment for Adrenal Insufficiency (Primary + Secondary)

Answer 1

Glucocorticoid Replacement

1. Hydrocortisone
2. Prednisone
3. Dexamethasone

Question 2

Mineralocorticoid Replacement for Tx of Primary Adrenal Insufficiency

Answer 2

Fludrocortisone

Question 3

Primary vs. Secondary Adrenal Insufficiency

Answer 3

Primary: Adrenal Gland not making hormone => low Cortisol, low Aldosterone
Secondary: Normal Adrenal Gland but low ACTH => low Cortisol, normal Aldosterone

Question 4

Which Glucocorticoid Tx can NOT be given SM? Why?

Answer 4

Prednisone!!

Requires 11-beta-HSD1 to activate to Prednisolone

Question 5

Which Enzyme deficiency cause Virilizing HTN? Why?

Answer 5

11-beta-OH
Increase of (1) Deoxycorticosterone (2) Androstenedione

Question 6

Which Enzyme deficiency cause Virilizing Hypotension? Why?

Answer 6

21-OH
Decrease (1) Aldosterone (2) Cortisol
Increase Androstenedione

Question 7

Which Enzyme Deficiency cause Non-Virilizing HTN?

Answer 7

17-alpha-OH
Decrease Androstenedione
Increase Aldosterone

Question 8

Ketoconazole MOA

Answer 8

Inhibit 17-alpha: decrease Cortisol

Inhibit 17,20: decrease DHEA

Question 9

Cortisol Synthesis Inhibitor

Answer 9

1. Ketoconazole
2. Metyrapone
3. Etomidate

Question 10

Cortisol Receptor Blockers

Answer 10

Mifepristone

Question 11

Enzyme targets for Sex hormone disorders?

Answer 11

1. 5-alpha-reductase

2. Aromatase

Question 12

Product of 5-alpha-reductase

Answer 12

Testosterone –> Dihydrotestosterone

Question 13

Product of aromatase

Answer 13

Testosterone –> Estradiol

Question 14

Adrenocorticoid Agents order of increasing

1. Anti-inflammatory effect
2. Salt-retaining Potency (MC activity)

Answer 14

1. Cortisol

Question 15

Adrenocorticoid agent with NO MC activity?

Answer 15

Dexamethasone

Question 16

1. Aldo Antagonist?

2. Why useful?

Answer 16

1. Spironolactone, Eplerenone

2. K+ sparing

Question 17

Loop diuretic waste K+ and Ca++

Answer 17

True

Question 18

Thiazie diuretic waste K+ and spare Ca++

Answer 18

True

Question 19

Sodium channel blockers

Answer 19

1. Amiloride

2. Triamterene

Question 20

APA treatment vs. IPA treatment

Answer 20

APA: (1) Aldo Antagonist (2) Surgery
IPA: (1) Aldo Antagonist (2) BP meds (CCB, ACEI, ARB)

Question 21

CCB

Answer 21

1. Nifedipine
2. Diltiazem
3. Verapamil

Question 22

Order CCB increasing order:

1. Dilation vessels

Answer 22

Diltiazem

Question 23

CCB increase HR

Answer 23

Nifedipine

Question 24

CCB decrease HR

Answer 24

Verapamil

Question 25

Phenoxybenzamine

Answer 25

irreversible alpha 1/2 antagonist

Question 26

Terazosin - Doxazosin

Answer 26

reversible alpha 1 antagonist

Question 27

Metoprolol vs. Labetalol

Answer 27

Metoprolol: beta-1 blocker
Labetalol: alpha 1 / beta 1/2 blocker

Question 28

Tx for Pheochromocytoma

Answer 28

1. alpha 1 blocker
2. beta 1 blocker
3. SURGERY!!