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Pharm II- Exam 2 > Adrenocorticosteroids & Adrenocortical Antagonists > Flashcards

Adrenocorticosteroids & Adrenocortical Antagonists Flashcards

1
Q

What do the adrenal glands produce?

A

steroid molecules

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2
Q

What controls secretion of the adrenal glands?

A

pituitary release of corticotropin (ACTH)

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3
Q

What controls the secretion of the salt retaining hormone aldosterone?

A

Angiotensin

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4
Q

What hypothalamic hormone stimulates the release of adrenocorticotropin from the adrenals?

A

Corticotropin-releasing hormone (CRH) (+)

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5
Q

The release of ACTH from the pituitary stimulates the ____ to release ____?

A

adrenal cortex

cortisol

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6
Q

What are the 3 pathways involved in adrenocortical hormone biosynthesis?

A

mineralocorticoid pathway
-aldosterone

glucocorticoid pathway
-cortisol

androgen & estrogen pathway

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7
Q

What are the physiologic effects of the adrenal hormones?

A

Regulation of intermediary metabolism

CV func

Growth

Immunity

Synthesis and secretion tightly regulated by CNS

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8
Q

The release of cortisol causes negative feedback on the ___ and ____.

A

anterior pituitary

hypothalamus

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9
Q

How much cortisol (hydrocortisone) do we release daily?

A

10-20mg

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10
Q

What controls circadian rhythm?

A

pulses of ACTH

peak in the early AM and after meals

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11
Q

What is corticosteroid binding globulin?

A

α2 globulin synthesized by the liver

Binds about 90% of the circulating cortisol under normal circumstances

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12
Q

What increases CBG? What decreases it?

A

pregnancy, estrogen administration, hyperthyroidism

hypothyroidism, genetic defects in synthesis, protein deficiency states

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13
Q

When are the actions of glucocorticoids most apparent?

A

in the fasting state when they contribute to maintenance of an adequate glucose supply to the brain

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14
Q

What is the half life? What can increase it?

A

60-90 mins

hydrocortisone when admin in large amounts, stress, hypothyroidism, liver disease

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15
Q

Where is cortisol metabolized? where is it excreted?

A

liver

urine

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16
Q

What are some adrenal cortex diseases?

A

Acute Adrenocortical Insufficiency
—Adrenal crisis

Chronic Adrenocortical Insufficiency
—-Addison’s Disease

Hypercortisolism
—Cushing’s Syndrome

Hyperaldosteronism

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17
Q

What is an adrenal crisis?

A

emergency state due to insufficient cortisol

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18
Q

Adrenal crisis is MCly seen in…

A

primary adrenal insufficiency, Addison’s Disease, than is disorders of the pituitary gland

19
Q

Sxs of adrenal crisis?

A

Low blood pressure, dehydration, skin pigmentation may be increased

Weakness, abdominal pain, fever, confusion, N/V/D

20
Q

How can you test for acute adrenocortical insufficiency?

A

Cosyntropin unable to stimulate an increase in serum cortisol to > 20mcg/ml

21
Q

Tx for adrenal crisis?

A

Hydrocortisone 100-300mg IV, then 50-100mg Q6-8hrs

Fludrocortisone Acetate

-consider if pts not response to fluids/vasopressors

22
Q

Examples of short-medium acting glucocorticoids…

A

Hydrocortisone*

Prednisone

Cortisone

Prednisolone

Methylprednisolone

23
Q

Example of intermediate acting glucocorticoid?

A

Triamcinolone

24
Q

What kind of steroid is fludrocortisone?

A

mineralocorticoid

25
Q

Name two long acting glucocorticoids. Which one is super potent??

A

Betamethasone

Dexamethasone***

26
Q

Cause of primary adrenal insufficiency?

A

dysfunction or absence of the adrenal cortices

27
Q

s/s of chronic adrenal insufficiency (Addison’s disease)

A

Skin pigmentation
Hypotension, small heart
Low serum sodium
Elevated K+, Ca++, BUN

28
Q

Tx for addison’s disease?

A

hydrocortisone +/- fludrocortisone

29
Q

how is hydrocortisone dosed in Addison’s disease?

A

15–30 mg orally daily is drug of choice with 2/3 of dose given in the am and 1/3 given in the late afternoon

30
Q

What kind of effect can be seen in pt taking Fludrocortisone acetate?

A

potent sodium retaining effect

31
Q

When might you increase dose of Fludrocortisone acetate?

when might you decrease?

A

if patient is experiencing:

Postural hypotension
Hyponatremia
Or hyperkalemia
OR fatigue

Edema
Hypokalemia
OR hypertension

32
Q

S/s of cushing’s syndrome

A

Central obesity, muscle wasting

Thin skin, hirsutism, purple striae

Psychological changes

Osteoporosis, hypertension, poor wound healing

elevated Sr cortisol

hyperglycemia

33
Q

Tx for cushing’s syndrome caused by pituitary adenoma?

A

transsphenoidal surg

radiation

chemo

Supplement with 6-37 mos of corticosteroids until func. of pituitary normalizes

34
Q

MOA of Ketoconazole in tx of cushing syndrome? contraindications?

A

blocks production of cortisol

hepatic disease

35
Q

If surg is not an option in pt with cushing disease, what medications can you try?

A

Mitotane, Metyrapone, Mifepristone, Cabergoline, Pasireotide

36
Q

What can cause hyperaldosteronism?

A

excess aldosterone secretion

low levels of angiotensin II

37
Q

What are the 2 forms of hyperaldosteronism?

A

Primary: aldosterone producing adenoma (Conn’s syndrome)

Secondary: low (suppressed) levels of plasma renin activity and angiotensin II

38
Q

Sxs of hyperaldosteronism?

A

Hypertension with hypokalemia or resistant HTN

Tetany/paralysis

Polydipsia/nocturnal polyuria

39
Q

What drugs can be used in the tx of hyperaldosteronism?

A

Amiloride
Eplerenone
Spironolactone

40
Q

ADEs of Amiloride? What should you monitor?

A

Electrolyte abnormalities (hyperkalemia), hypotension, N/V/D, HA

Monitor: Sr Cr, K, BP

41
Q

ADEs of Eplerenone? What should you monitor?

A

Electrolyte abnormalities (hyperkalemia), hypotension, dizziness, headache; gynecomastia and menstrual irregularities are uncommon

Monitor: Sr Cr, K, BP

42
Q

ADEs of Spironolactone? What should you monitor?

A

GI discomfort, impotence, gynecomastia, menstrual irregularities, electrolyte abnormalities (hyperkalemia), hypotension

Monitor: Sr Cr, K, BP

43
Q

What’s the MC cause of cushing’s?

A

exogenous steroids

Pharm II- Exam 2 (4 decks)

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