APH Axis

Question 0

Hydrocortisone

Answer 0

Cortisol
Mineralocorticoid & glucocorticoid (1:1)
Weak anti-inflammatory, glucocorticoid replacement (adrenal insuff)

Question 1

Fludrocortisone

Answer 1

Glucocorticoid & mineralocorticoid
Similar actions to Aldosterone,
Combine w/ a glucocorticoid for replacement tx in adrenocortical insufficiency (de Na+, dehydration, inc K+, arrhythmias)

Question 2

Cortisone

Answer 2

Mineralocorticoid, glucocorticoid

First converted to hydrocortisone in liver (so less potent)

Question 3

Prednisone

Prednisolone

Answer 3

Glucocorticoid > mineralocorticoid

Prednisone first converted to prednisolone by liver to be active

Question 4

TRiamcinolone

Methylprednisolone

Answer 4

Glucocorticoid (no mineralocorticoid activity

Anti-inflammatory only

Question 5

Dexamethasone

Answer 5

Glucocorticoid (high potency)- Antiinflammatory
For cerebral edema (x CNS)
Used to measure endogenous cortisol levels (no x-rxn)
Joint injection in RA

Question 6

Fluticasone

Answer 6

Glucocorticoid, inhaled/intranasal use

Inhaled- DOC for asthma (+long acting B-agonist: salmeterol)

Question 7

Aminoglutethimide

Answer 7

Cytadren -Off market
Inhibits cholesterol-> pregnenolone, so inhibits all steroid synth
For cushings, breast and prostate Ca (that doesn’t respond to tamoxifen or antiandrogen tx).
Adverse: adrenal insuff, give w/ glucocorticoids

Question 8

Mitotane

Answer 8

Adrenocorticolytic (adrenocortical atrophy)
For: 1ary adrenal carcinoma, some Cushing’s remission
Adverse: severe GI
Induces hepatic enzymes

Question 9

Metyrapone

Answer 9

selective inhibitor of corticol synth ezyme, dec aldosterone & cortisol
For: tests of adrenal fx, short term during Cushings determination
ONLY DRUG OK IN PREGNANCY
Adverse: less than mitotane, GI, sedation, dizzi, rash, hirsutism

Question 10

MEfepristone

Answer 10

Anti progesterone, and anti glucocorticoid
For inoperable Cushing’s not responding to tx
Adverse: abdo, amenorrhea, fatigue, GI