Drugs Acting on the Adrenal Cortex

Question 1

What section of the adrenal glad produces Mineralocorticoids?

Answer 1

Zona glomerulosa in the cortex

Question 2

What second of the adrenal gland produces Glucocorticoids?

Answer 2

Zona fasciculata in the cortex

Question 3

What effect do glucocorticoids have on energy metabolism?

Answer 3

Catabolic, antagonistic to insulin

Question 4

How do glucocorticoids alter calcium metabolism?

Answer 4

Decrease GI absorption and increase urinary excretion

Question 5

What 3 things do glucocorticoids cause with regards to water?

Answer 5

PU
PD
Increased GFR

Question 6

What effect can glucocorticoids have on the heart? (2 things)

Answer 6

Chronotropic

Inotropic

Question 7

What type of leukogram do you see with glucocorticoid use?

Answer 7

Stress

Question 8

What 3 hematology values increase with glucocorticoid use?

Answer 8

PCV
Platelets
Clotting/platelet function

Question 9

What blood chem value will usually increase with glucocorticoid use?

Answer 9

ALP

Question 10

What blood chem values (4) may increase with glucocorticoid use?

Answer 10

ALT
GGT
Cholesterol/TGs
Glc (+/-)

Question 11

What blood chem values (2) may decrease with glucocorticoid use?

Answer 11

BUN

T3/T4

Question 12

What 3 things might you see in the nervous system with glucocorticoid use in animals?

Answer 12

Polyphagia
Peripheral neuropathies
Euphoria/depression

Question 13

What can glucocorticoid use mask?

Answer 13

A febrile response

Question 14

What 3 things can you see in the skin with chronic excess of glucocorticoids?

Answer 14

Mineralization (Calcinosis cutis)
Thinning and weakening of skin
Alterations in hair turnover

Question 15

What can you see in the bones of animals being treated with glucocorticoids?

Answer 15

Osteoporosis (increased osteoclasts, decreased osteoblasts)

Question 16

T/F: Glucocorticoids inhibit fibroblasts.

Answer 16

True

Question 17

What two reproductive processes are inhibited by glucocorticoid use?

Answer 17

Spermatogenesis

Ovulation

Question 18

What detrimental effects can glucocorticoids have on fetal development>

Answer 18

Teratogenic

Induce abortion/parturition

Question 19

What effect does glucocorticoid use have on the stomach?

Answer 19

GI ulceration

Question 20

How do glucocorticoids cause GI ulceration? (2 things)

Answer 20

Increased acid secretion

Decreased mucus secretion

Question 21

What causes significant risk of GI ulcerations if used with glucocorticoids?

Answer 21

NSAIDs

Question 22

What can you see in the liver from glucocorticoid use?

Answer 22

Fatty liver

Question 23

Can glucocorticoid use directly cause pancreatitis?

Answer 23

No

Question 24

What sort of immunologic effect does glucocorticoid use have? (2 things)

Answer 24

Anti-inflammatory

Immune suppression

Question 25

What type of cellular effects does glucocorticoid use have on the leukocytes? (5 things)

Answer 25

``` Inhibits leukocyte recruitment Decrease phagocytosis Reduce bactericidal activity Inhibit inflammatory mediators Suppresses fibroplasia/granulation tissue ```

Question 26

What "dose-related effect" do glucocorticoids have on the immune system?

Answer 26

Lower dose = anti-inflammatory | Higher dose = immunosuppressive

Question 27

Where are glucocorticoids readily absorbed from?

Answer 27

GIT Skin MM

Question 28

What sort of protein binding do glucocorticoids have?

Answer 28

High affinity for transcortin | Low affinity for albumin

Question 29

What 3 glucocorticoids need hepatic metabolism to be activated?

Answer 29

Methylprednisone Prednisone Cortisone

Question 30

What kind of distribution do glucocorticoids have in the body?

Answer 30

Wide, including CNS

Question 31

Where are glucocorticoid metabolites excreted?

Answer 31

In the urine

Question 32

What are some major contraindications for glucocorticoid use? (name 3... list of 7)

Answer 32

``` Diabetes mellitus Infection Corenal ulceration Young animals Pregnant animals Surgical patients Preexisting catabolic disease ```

Question 33

Are glucocorticoids an enzyme inducer or inhibitor?

Answer 33

Inducer

Question 34

What do you NEVER use with glucocorticoids?

Answer 34

NSAIDs

Question 35

What general side effects can you see with short-term (3-5 days) glucocorticoid use? (3 things)

Answer 35

Labwork changes PU/PD/Polyphagic Fetal abnormalities.abortion

Question 36

What side effects can you see with long-term (>1 week) glucocorticoid use? (6 things)

Answer 36

``` Increased susceptibility to infectino Poor healing Skin changes Hypertension Panting Addisonian signs (withdrawal) ```

Question 37

What must be considered with glucocorticoid therapy if discontinuing?

Answer 37

Taper dose

Question 38

What are 3 things to consider with glucocorticoid use?

Answer 38

Potency Duration of Action Require activation?

Question 39

How are steroids divided for duration?

Answer 39

Short Intermediate Long

Question 40

What do salt esters (Sodium Phosphate and Sodium succinate) do to glucocorticoids? (2 things)

Answer 40

IV injection | Larger volumes

Question 41

Do salt esters effect the duration of glucocorticoids?

Answer 41

No

Question 42

What do insoluble esters (acetate, acetonide) do to glucocorticoids? (2 things)

Answer 42

Longer absorption | Delay onset

Question 43

Do insoluble esters effect the duration of glucocorticoids?

Answer 43

Yes, prolonged

Question 44

What are insoluble esters also considered?

Answer 44

Depot injection

Question 45

What are long-acting glucocorticoids?

Answer 45

Betamethasone | Dexamethasone

Question 46

What are intermediate glucocorticoids?

Answer 46

Triamcinolone

Question 47

What are short-acting glucocorticoids?

Answer 47

Hydrocortisone Prednisolone Prednisone Methylprednisone

Question 48

What suspensions mean topical use for glucocorticoids?

Answer 48

Fluorination or esterification with fatty acids or cyclic acetonides (acetate or acetonamide)

Question 49

What is an excipient?

Answer 49

Anything that alters the kinetics of the drug (eg. different propellant to get better lung dispersion)

Question 50

What glucocorticoid is an inhalant?

Answer 50

Fluticasone diproprionate

Question 51

What steroid is ~15x more potent that prednisolone?

Answer 51

Budesonide

Question 52

Where do mineralocorticoids have their effect?

Answer 52

Na+ retention in the kidney and K+ excretion

Question 53

What is the endogenous mineralocorticoid?

Answer 53

Aldosterone

Question 54

What are mineralocorticoids used to treat?

Answer 54

Addison's

Question 55

What 2 drugs are used to treat Addisons?

Answer 55

DOCP | Fludrocortisone (Florinef)

Question 56

What is hypoadrenocorticism?

Answer 56

Addison's

Question 57

What is iatrogenic hypoadrenocorticism?

Answer 57

Suppressed adrenals with exogenous steroids.

Question 58

How do you treat iatrogenic hypoadrenocorticisim?

Answer 58

Wean off steroid

Question 59

What is "typical" Addison's?

Answer 59

Deficient in both mineralocortiocid and glucocorticoid

Question 60

How do you treat typical Addison's?

Answer 60

Florinef or DOCP and Prednison

Question 61

What is "atypical" Addison's?

Answer 61

Deficient in glucocorticoid ONLY

Question 62

How do you treat atypical Addison's?

Answer 62

Prednisone only

Question 63

What is the common name for hyperadrenocorticism?

Answer 63

Cushing's

Question 64

What 2 things are commonly used to treat hyperadrenocorticism?

Answer 64

Mitotane | Trilostane

Question 65

What do you need to be careful with when using Mitotane?

Answer 65

Cytotoxic

Question 66

What can greatly increase absorption of Mitotane?

Answer 66

Oil (caution owners in case they supplement oils)

Question 67

How does Trilostane work?

Answer 67

Competitive inhibitor of steroid synthesis

Question 68

What 2 drugs are uncommonly used to treat hyperadrenocorticism?

Answer 68

Ketoconazole | Selegiline (L-Deprenyl) (Anipryl)

Question 69

What is use to treat hyperadrenocorticism in horse?

Answer 69

Pergolide