Chapter 28: Adrenal Cortex Flashcards
What glucocorticoid receptor agonists are available in an inhaled form? What are these used to treat?
FB FB T (fluticasone, beclomethsone, flunisolide, triamclinolone, budeosonide)
Chronic asthma
What glucocorticoid receptor agonists are used cutaneously for things like psoriasis and dermatitis?
Methylprednisolone
Dexamethasone
Hydrocortisone
Which glucocorticoid receptor agonist has a long duration of action?
Dexamethasone
D is for Duration
What is the relationship between glucocorticoid anti inflammatory potency and duration of action?
The greater the anti-inflammatory potency the longer the duration of action
What do you need to keep in mind when switching a patient from oral glucocorticoids to inhaled?
Do not switch abruptly - wean off, especially if oral is high dose.
Administering glucocorticoids can lead to what major adverse effects?
Osteoporosis (because of decreased osteoblast activity)
Hypercortisolism w/ Cushing-like symptoms
Growth retardation
Diabetes mellitus
What is a negative effect of inhaled glucocorticoids? How can you advise a patient to avoid this?
Oropharyngeal candidiasis
Rinse mouth with water thoroughly after each use
Think of your symbicort
Which glucocorticoid can be administered to a pregnant woman without affecting the baby?
Prenisone
P is for Pregnant
Which glucocorticoid would you prescribe to promote fetal lung development? (i.e. which will cross placental barrier..?)
Dexamethasone
Intra-articular glucocorticoid depots are used to treat what types of conditions?
Gout, arthritis
Mifepristone is used for what?
Abortion through day 49 of pregnancy
How does the MOA of mifepristone differ at low versus high doses?
Progesterone receptor antagonist
Higher concentrations: blocks glucocorticoid receptor (could then be used for ridiculously high ACTH levels…)
Mitotane MOA
Structural DDT analogue
Toxic to adrenocortical mitochondria!!! AHHHH kills that mito MITO-tane
What is mitotane used for?
Medical adrenalectomy in severe Cushing’s or adenocortical carcinoma…
Because it is toxic to the adrenocortical mitochondria, mitotane will destroy that shit …
so too much cortisol or ACTH? BAM.
Why can mitotane cause hypercholesterolemia?
Because mitotane may also inhibit cholesterol oxidase = buildup of cholesterol
What drug would you use to treat Cushing’s syndrome in DOGS only?
Trilostane (inhibits 3B hydroxysteroid dehydrogenase)
What drug inhibits side-chain cleavage enzyme as well as aromatase - and is used to treat Cushing’s syndrome?
Aminoglutethimide
Which drug is used for diagnostic evaluation of the hypothalamic-pituitary-adrenal axis? What is the MOA?
Metyrapone
Inhibits 11B hydroxylation –> impaired cortisol and aldosterone synthesis
Ketoconazole
Antifungal agent that generally inhibits the wide range of adrenocortical hormones
What is Fludrocortisone?
Mineralcorticoid receptor agonist - like aldosterone
But we use this instead of aldosterone because fludrocortisone has a minimal first pass metabolism
Flud–>Fluid–>aldosterone
What do we use fludrocortisone for?
hypoaldosteronism - not enough aldosterone? give this crap!
When would we want to use mineralcorticoid receptor ANTAGONISTS?
antagonists would inhibit aldosterone action so that we didn’t retain so much Na and Water….so this would DECREASE BP
Would use in heart failure patients as antihypertensive agents!
Spironolactone MOA
mineralcorticoid receptor antagonist
Eplerenone MOA
mineralcorticoid receptor antagonist
