B14-3 Adrenal And Bone

Question 1

Ketoconazole: MOA & used for what?

Answer 1

• blocks 17-alpha hydroxylase

- Tx for Cushing’s Syndrome (think “cushin’” as in “Fat”, so need a “KETO” diet)

Question 2

Spironolactone (mineralcorticoid): MOA? Uses?

Answer 2

• Inhibits aldosterone (blocks receptors) which stimulates reabsorption of Na+ and secretion of K+ and H+; therefore, this is a K+ sparing diuretic
• Tx for Hyperaldosteronism or Conn Syndrome

Question 3

Signs/symptoms of hyperaldosteronism aka Conn Syndrome? Primary cause?

Answer 3

• Sodium and water retention (causing hypertension)
• Metabolic alkalosis
• Severe hypokalemia

Question 4

Name 2 drugs (and their classes) that can be used to treat adrenal insuficiency in Addisons disease. What else can these be used for?

Answer 4

• Fludrocortisone (mineralcorticoid) & Hydrocortisone (glucocorticoid)
• IV for acute cases like adrenal hemorrhage from septicemia

Question 5

What does PTH (parathyroid hormone) do?

Answer 5

• decreases calcium excetion
• increases bone resorption
• Increases phosphate excretion by the kidneys
• Increases calcitriol production by the kidneys

Question 6

What two supplements can be given for acute hypocalcemia? How are they given?

Answer 6

• Calcium carbonate and calcium chloride

- IV ONLY

Question 7

What is Sevelamer? What is it used for?

Answer 7

• phosphate binder

- Tx for hyperphosphatemia

Question 8

Name the 3 kinds of Vitamin D and where they come from

Answer 8

• Calcitrol: formed by the kidney in response to PTH
• Cholecalciferol (Vitamin D3) - made in the skin and in animal foods (fish oil, liver, egg yolk)
• Ergocalciferol (Vitamin D2) - plant source foods

Question 9

Name the first line treatment for Osteoporosis? What kind of drug is it? How does it work? Special considerations and box warnings?

Answer 9

• Alendronate
• Biphosphonate
• binds to sites of bone remodeling
• Patient must stand or sit for 30-60 minutes due to esophageal erosion issues
• Box warning for atypical femur fractures, osteonecrossis of the jaw, esophageal cancer

Question 10

Name a SERM that can be used for osteoporosis. Any contraindications?

Answer 10

• Raloxifene

- do not give if they have a Hx of thromboembolic events

Question 11

What kind of drug is Denosumab? MOA? Contraindications?

Answer 11

• IgG2 monoclonal antibody (biologic)
• binds to RANKL
• do not give to pt with hypocalcemia

Question 12

Name 2 calcitonin drugs. Contraindicated for who?

Answer 12

• Miacalcin and Fortical

- pt with a salmon allergy

Question 13

What is the last line of Tx for osteoporosis? Contraindicated for who?

Answer 13

• Estrogen

- pt with a Hx of thromboembolic events, severe liver disease, breast cancer

Question 14

What causes Cushing’s? How do patients present?

Answer 14

• Hypercortisolism
• Buffalo Hump
• Moon face
• skin changes

Question 15

How do you treat ACTH dependent Cushings Syndrome?

Answer 15

Ketoconazole

Question 16

How do you treat ACTH independent Cushings Syndrome?

Answer 16

Lower or stop steroid use

Question 17

What is Addisons disease?

Answer 17

• Chronic adrenal insufficiency, typically due to adrenal atrophy secondary to an autoimmune condition