Chapter 43 - Addison's and Cushing's Disease

Question 1

Adrenocorticoids/Mineralcorticoids

• Hydrocortisone cypionate (Cortef)

Answer 1

 Hydrocortisone cypionate (Cortef)
 MOA: Hydrocortisone decreases inflammation; the mineralcorticoid in the drug increases the retention of sodium
 Use: Addison’s disease, replace adrenocorticoids and mineralcorticoids
 AE: Cardiac effects (fluctuations in BP, shock, dysrhythmias, myocardial infarction, embolism, circulatory collapse, heart failure, and cardiac arrest); CNS effects (vertigo, h/a, and depression); dermatologic effects (fragile skin that tears easily, petechiae, ecchymoses); GI effects (peptic or esophageal ulcers, pancreatitis, increased appetite, and weight gain); Hematologic effects (sodium and fluid retention); Metabolic effects (hyperglycemia and Cushing’s syndrome); Musculoskeletal effects (osteoporosis and spontaneous fractures with long term admin); Reproductive (female) effects (amenorrhea and irregular menses); Other effects (immunosuppression, muscle weakness, impaired wound healing, and anaphylaxis)
 Contra: Serious infection
 BBW: Those being treated with hydrocortisone should not receive live virus vaccines

Question 2

Mineralcorticoids

• fludrocortisone acetate (Florinef Acetate)

Answer 2

 fludrocortisone acetate (Florinef Acetate)
 MOA: Produces sodium retention and potassium excretion to increase BP
 Use: Partial replacement of mineralcorticoids in treatment of primary and secondary adrenocortical insufficiency from Addison’s disease
 AE: HPA axis suppression, growth suppression, hyperglycemia and hypokalemia alkalosis, HF, edema, HTN, peptic ulcer, acne, bruising, rash, cataracts, muscle weakness, diaphoresis

Question 3

11-Deoxycortisol Inhibitors

• ketoconazole (Nizoral)

Answer 3

 ketoconazole (Nizoral)
 MOA: Inhibits enzymes involved in cortisol synthesis
 Use: Cushing’s Disease