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Summer pharm exam 2 > Adrenals > Flashcards

Adrenals Flashcards

1
Q

What do the adrenals secrete

A

steroid molecules; stimulated by ACTH from pituitary

-aldosterone controlled by angiotensin

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2
Q

What is the backbone of all major steroids

A

cholesterol

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3
Q

What are the effects of the adrenal hormones

A

regulate metabolism
cardiovascular function
growth
immunity

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4
Q

Synthesis and secretion of the adrenal hormones is regulated by

A

CNS- sensitive to negative feedback by circulating cortisol and exogenous synthetic glucocorticoids

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5
Q

What is the HPA axis

A

Hypothalamus sends signal to Pituitary
Pituitary to adrenals
adrenals with negative feedback to pituitary and hypothalamus

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6
Q

How is Cortisol (hydrocortisone) secreted

A

in a circadian rhythm, pulsatile

peak in early AM and after meals (esp lunch)

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7
Q

What is CBG (cortisol binding globulin)

A

made in liver, binds 90% of cortisol normally
increases in pregnancy, estrogen administration, and hyperthyroid
decreases in hypothyroid, protein deficiency, and genetic defects
*Synthetic steroids (DXM) bind to albumin, not CBG

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8
Q

Vascular and smooth muscle respond to

A

catecholamines; response is lower without cortisol

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9
Q

Glucocorticoid actions are most apparent when

A

in the fasting state- they contribute to maintaining adequate glucose supply to the brain

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10
Q

Some functions of cortisol include

A

gluconeogenesis
release AA from muscle catabolism
inhibit peripheral glucose uptake
stimulate lipolysis

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11
Q

What are the pharmacokinetics of cortisol

A

half life 60-90 minutes
increased if stressed, hypothyroid, or with liver dz
metabolized in liver
excreted in urine

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12
Q

What are the diseases of the adrenal cortex

A

acute adrenocortical insufficiency (adrenal crisis)
chronic adrenocorticol insufficiency (addison’s dz)
hypercortisolism (cushing’s syndrome)
hyperaldosteronism

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13
Q

What is an adrenal crisis

A

insufficient cortisol causing weakness, abdominal pain, fever, confusion, N/V/D, Low BP- increased skin pigment
MC een in primary adrenal insufficiency, not pituitary d/o

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14
Q

How can you test for adrenal crisis

A

Cosynotropin (synthetic ACTH) Stimulation test

normal response: increase serum cortisol 20mcg+

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15
Q

How do you treat acute adrenal insufficiency

A

Hydrocortisone 100-300mg

Fludrocortisone acetate PO (mineralocorticoid to reduce edema)

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16
Q

What steroids are preferred

A
  1. Hydrocortisone
  2. Prednisone
    -Fludrocortisone ONLY for BP management
    Rarely used is dexamethasone
    *Topicals have no effect on adrenal insufficiency
17
Q

What is an important ADE of fludrocortisone

A

salt and fluid retention (CHF)

18
Q

What is Addison’s disease

A

primary adrenal insufficiency 2/2 dysfunction or absence of the adrenal cortices

19
Q

Symptoms of Addison’s disease include

A 
Akin pigmentation 
hypotension, small heart 
hyponatremia 
hyperkalemia, hypercalcemia
high BUN 
weakness, anorexia, weight loss, amenorrhea 
high ACTH, low cortisol
20
Q

How do you treat Addison’s disease

A

Corticosteroids (alone if mild) or + Mineralocorticoids (fludrocortisone) with aggressive IV saline and glucose

  • *Hydrocortisone 2/3 in AM, 1/3 in late afternoon (alternate is prednisone)
  • Fludrocortisone acetate (sodium retention)
21
Q

How does dosing change

A

Increase if with: postural hypotension, hyponatremia, hyperkalemia, or fatigue
Decrease if: edema, hypokalemia, hypertension

22
Q

Why do some with Addison’s disease take DHEA

A

provides improved sense of well being
increased muscle mass
reversal of bone loss at femoral neck
*monitor older women for androgen effects

23
Q

If someone with Addison’s has an episode, how do you treat

A

minor stress glucocorticoid coverage: 2x replacement of hydrocortisone over 24 hrs
major stress glucocorticoid coverage: 10x replacement of hydrocortisone over 48 hrs

24
Q

How does prednisone work

A

activates glucocorticoid receptor and alters gene transcription

25
Q

Prednisone ADe include

A 
adrenal suppression 
inhibits growth 
muscle wasting 
salt retention 
osteoporosis 
glucose intolerance
26
Q

What is cushing’s syndrome

A

Hypercortisolism either from exogenous drug admin or excess production
-small percent from ACTH secreting neoplasms; also can be from excess GHB ingestion
MC in women

27
Q

S/Sx of Cushing’s syndrome are

A 
central obesity 
thin skin
purple striae 
osteoporosis 
HTN 
hyperglycemia 
hypokalemia 
hirsutism 
muscle wasting
28
Q

How do you treat Cushing’s 2/2 pituitary adenoma

A

TSS (resection)
Irradiation is non-resectable
gamma knife radiation
6-36 moths of corticosteroids (until pituitary fxn normalizes)

29
Q

Examples of drugs to treat cushing’s syndrome are

A

Ectopic ACTH syndrome: Ketoconazole
Pit dependent: Mitotane, Cabergoline, Pasireotide
Adrenal adenoma: ketoconazole
Adrenal carcinoma: mitotane

30
Q

What are the forms of hyperaldosteronism

A

primary: Aldosterone producing adenoma (Conn’s syndrome), d/o of adrenal steroid biosynthesis
secondary: low renin/angiotensin II

31
Q

What are symptoms of hyperaldosteronism

A

HTN with hypokalemia, resistant HTN
tetany/paralysis
polydipsia, nocturnal polyuria

32
Q

What drugs help treat hyperaldosteronism

A

Amiloride
Eplerenone
Spironalactone

33
Q

What are ADE of hyperaldosterone Tx drugs

A

Amiloride: hyperkalemia, hypotension, n/v/d, HA
Eplerenone: hyperkalemia, hypotension, dizzy, HA
Spironalactone: hyperkalemia, GI discomfort, impotence, gynecomastia, irregular menses, hypotension

34
Q

What is the easiest test to run for Cushing’s syndrome

A

Dexamethasone suppression test
Give DXM 1mg at 2300, it should suppress cortisol to <5mcg by 0800 the next morning
If cortisol is not decreased by 5, then you have hypercortisolism

35
Q

What test confirms Cushing’s after a positive DXM suppression test

A

24 hour free urinary cortison and creatinine

if abnormally high (>95) you probably have cushing’s

Summer pharm exam 2 (6 decks)

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