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LECOM pharmacology notecards > chapter 28- pharmacology of adrenal cortex > Flashcards

chapter 28- pharmacology of adrenal cortex Flashcards

1
Q

what does the outer adrenal cortex originate from

A

mesoderm

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2
Q

what does the inner adrenal medulla originate from

A

neural crest cells

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3
Q

what does the glomerulosa produce

A

mineralocorticoids

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4
Q

what is the glomerulosa under the control of

A

angiotensin II, blood potassium concentration, and to lesser extent ACTH

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5
Q

what does the fasciculata produce

A

glucocorticoids

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6
Q

what does the reticularis produce

A

androgens

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7
Q

what is cortisol synthesized from

A

cholesterol

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8
Q

what is the primary site of peripheral cortisol metabolism

A

liver and kidneys

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9
Q

what concerts cortisol to biologically inactive compound cortisone

A

11-beta hydroxysteroid dehydrogenase type 2

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10
Q

what is the precursor peptide of ACTH

A

POMC

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11
Q

what is the most common cause of addison’s disease

A

T-cell mediated autoimmune reaction selectively destroying the adrenal cortex

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12
Q

what does pharmacologic levels of glucocorticoids inhibit the cytokine release of

A

IL-1, IL-2, IL-6, TNF-alpha action

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13
Q

what is the site of action of mitotane

A

mitochondria

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14
Q

what is the site of action of aminoglutethimide

A

side-chain cleavage enxyme

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15
Q

what is the site of action of ketoconazole

A

primarily 17, 20-lyase

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16
Q

what is the primary site of action of metyrapone

A

11-beta hydroxylase

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17
Q

what is the site of action of trilostane

A

3 beta hydroxysteroid dehydrogenase

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18
Q

what adrenal cortex drugsinhibit early stages in adrenal hormone synthesis

A

mitotane, aminoglutethimide, and ketoconazole

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19
Q

what is mitotane a structural analogue of

A

DDT

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20
Q

what glucocorticoid has the highest potency

A

dexamethasone

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21
Q

what is the change made to make fluticasone

A

addition of alpha fluorine to carbon 9

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22
Q

what is the drug of choice to replace both glucocorticoids and mineralocorticoids

A

Hydrocortisone

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23
Q

what glucocorticoid receptor agonist can cross the placenta in active form

A

dexamethasone

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24
Q

what are the clinical application of glucocorticoid receptor agonists

A

inflammatory conditions in many organs, autoimmune disease

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25
Q

what glucocorticoid receptor agonist can also be used as replacement therapy for primary and secondary adrenal insufficiency

A

hydrocortisone

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26
Q

what are the major adverse effects of inhaled glucocorticoid receptor agonists

A

oropharyngeal candidiasis and dysphonia

27
Q

what is the major adverse effect of topical glucocorticoids on skin

A

skin atrophy

28
Q

what is the major contraindication of glucocorticoid receptor agonists

A

systemic fungal infection

29
Q

what are the inhaled glucocorticoids

A

fluticasone, beclomethasone, flunisolide, triamcinolone, budesonide

30
Q

what is the major glucocorticoid receptor antagonist

A

mifepristone

31
Q

what is the clinical application of mifepristone

A

abortion (through day 49 of pregnancy)

32
Q

what are the common adverse effects of mifepristone

A

prolonged bleeding time, bacterial infections, sepsis, abnormal vaginal bleeding

33
Q

what are the contraindications of mifepristone use

A

chronic adrenal failure, ectopic pregnancy, hemorrhagic disorders, anticoagulation therapy, inherited porphyria, intrauterine device, undiagnosed adnexal mass

34
Q

what can high doses of mifepristone be used for

A

ectopic ACTH syndrome

35
Q

what is the mechanism of action of mitotane

A

inhibitor of glucocorticoid synthesis

36
Q

what is the clinical application of mitotane

A

medical adrenalectomy in cases of severe bushings syndrome or adrenocortical carcinoma

37
Q

what are the common adverse effects of mitotane

A

visual disturbance, hemorrhagic cystitis, hypercholesterolemia, somnolence, depression

38
Q

what is the contraindication of mitotane

A

live rotavirus vaccine

39
Q

what is mitotane the structural analogue of

A

DDT

40
Q

what does the hypercholesterolemia that may result from mitotane result from

A

inhibition of cholesterol oxidase

41
Q

what is the clinical application of aminoglutethimide

A

cushing syndrome; breast cancer

42
Q

what are the adverse effects of aminoglutethimide

A

cortisol insufficiency, agranulocytosis, leukopenia, neutropenia, pancytopenia, pruritis, somnolence

43
Q

what does minoglutethimide inhibit

A

side chain cleavage enzyme as well as aromatase

44
Q

what is aromatase important for conversion of

A

androgens to estrogens

45
Q

what is the clinical application of metyrapone

A

diagnostic eval of hypothalamic-pituitary-adrenal axis (ACTH reserve)

46
Q

what are the adverse effects of metyrapone

A

cortisol insufficiency, HTN

47
Q

what is the contraindication for metyrapone

A

adrenal cortical insufficency

48
Q

what does metyrapone inhibit

A

11-beta hydroxylation

49
Q

what is the clinical application of trilostane

A

Cushings syndrome in dogs

50
Q

what are the adverse effects of trilostane

A

addisonian crisis, postural hypotension, hypoglycemia, diarrhea, nausea

51
Q

what are the contraindications of trilostane use

A

adrenal cortical insufficiency, renal or hepatic dysfunction

52
Q

what does trilostane inhibit

A

3 beta hydroxysteroid dehydrogenase

53
Q

what is the role of 3 beta hydroxysteroid dehydrogenase

A

reduces aldosterone and cortisol production in adrenal cortex

54
Q

what does ketoconazole inhibit

A

p450

55
Q

what is the mechanism of action of fludrocortisone

A

agonist at mineralocorticoid receptor

56
Q

what is the clinical application of fludrocortisone

A

hypoaldosteronism

57
Q

what are the major adverse effects of fludrocortisone

A

HTN, hypokalemia, heart failure, thrombophlebitis, increased intracranial pressure

58
Q

what is the contraindication of fludrocortisone

A

systemic fungal infection

59
Q

what levels in blood should be monitored closely with fludrocortisone use

A

serum potassium and blood pressure

60
Q

what is DHEA

A

pro hormone that is converted to tester one in periphery

61
Q

what are adverse effects of DHEA

A

acne, hepatitis, hirsutism, androgenization

62
Q

what are the contraindications of DHEA

A

breast, ovarian or prostate cancer

63
Q

what is DHEA commonly abused for

A

anabolic effects

LECOM pharmacology notecards (22 decks)

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