Adrenal Steroid Inhibitors

Question 1

mitotane

Answer 1

adrenal cytotoxic agent; necrosis of zona fasciculata and reticularis; caution with renal and hepatic disease

ADVERSE EFFECTS:

lethargy, ataxia, weakness, GI, addisonian crisis, liver changes

Question 2

trilostane

Answer 2

competitive inhibitor of 3-beta hydroxysteroid dehydrogenase which decreases synthesis of cortisol, aldosterone, and adrenal androgens; caution with renal and hepatic disease

ADVERSE EFFECTS: lethargy, electrolyte abnormalities, GI

Question 3

ketoconazole

Answer 3

Increased fungal cellular membrane permeability

growth inhibition (ergosterol synthesis)

inhibition of 5 lipooxygenase

suppression of T lymphocyte proliferation

reduces testosterone/cortisol synthesis; caution in liver disease
Must reduce dose of cyclosporine - interferes with metabolism

ADVERSE EFFECTS:

teratogenic, GI, hepatotoxic, thrombocytopenia

Question 4

Selegeline

Answer 4

monamine oxidase inhibitor - increased dopamine levels resulting in decreased ACTH production

ADVERSE EFFECTS:
GI, CNS, repetitive movements, salivation