Endocrine: Adrenal Drugs Flashcards
Three Types of Corticosteroids
Glucocorticoids —- Cortisol
Mineralocorticoids —- Aldosterone
Sex Steroids —- DHEA, Androstenedione, Testosterone
Mineralcorticoid Actions
- INC Na+ reabsorption from the DCT and CD
- INC K+ and H+ Excretion in Urine
Glucocorticoid Actions: Carbohydrates
- Promotes Gluconeogenesis
- Inhibit peripheral utilizations and stimulating glucose release from liver
Glucocorticoid Actions: Proteins
- INC Breakdown of bone, muscle, fat and skin
- Mobilization of amino acids for glucose production
- Negative nitrogen balance (more nitrogen excreted than taken in)
Glucocorticoid Action: Fat
- Lipolysis
- Redistribution of fat
Glucocorticoid Action: Lymph Nodes
- INC in destruction of lymphoid cells
Glucocorticoid Action: CVS
- INC Capillary Permeability
Glucocorticoid Action: Inflammation
- DEC Inflammatory cell recruitment
- DEC inflammatory cytokines
- Inhibit PLA2 — DEC PGs and LTs
Glucocorticoid Action: Immunity
- Inhibit fxn of macrophages and presenting cells
- Inhibit IL1 and IL2
- Suppression of NK Cells
Excess Cortisol Manifestations
- INC Protein Catabolism
- INC Glucose Production (DM)
- Truncal Obesity
- Osteoporosis (bone breakdown)
- Catechol synth (HTN)
- Immunosuppression (opportunistic infxns)
- Inhibition of HPG Axis (Amenorrhea, impotence)
- Depression and memory difficulties
Cushing’s Syndrome
- Cortisol Excess from any source
- Most common non-iatrogenic source is a Pituitary Adenoma
S/Sx: Moon face, mood swings, HTN, Obesity, Purpura, poor wound healing, thin wrinkled skin, buffalo hump
Short to Medium Acting Glucocorticoids
“Hi Can the Prime Minister Play?”
- Hydrocortisone
- Cortisone
- Prednisone
- Prednisolone
- Methylprednisone
Intermediate Acting Glucocorticoids
“Do you have TP?”
- Triamcinolone
- Paramethasone
Long Acting Glucocorticoids
“Beth and Dex do Meth w/ their Son”
- Bethamethasone
- Dexamethasone
Mineralocorticoids
“He was DOA w/ the Flu”
- Fludrocortisone
- DesOxycorticosterone Aceteate (DOA)
Topical Steroid Preparations
“BBF not BFF”
- Beclomethasone
- Budesonide
- Fluticasone
Acute Adrenal Insufficiency, S/Sx and Tx
S/Sx: Nausea, Vomiting, Abd pain, Hyponatremia, Hyperkalemia, weakness, Hypotension, Dehydration
Tx: IV D5NS, Hydrocortisone Infusion and fix the precipitating cause (Infxn, trauma, hemorrhage)
Chronic Adrenal Insufficiency (Addison’s) S/Sx and Tx
S/Sx: Weight loss, hypotension, fatigue, weakness
Tx: Daily Corticosteroids and Mineralocorticoid replacement (Fludrocortisone Acetate)
Congenital Adrenal Hyperplasia, Cause and Tx
- CYP21 defect
TX: Hydrocortisone and Mineralocorticoid (for salt wasting)
Non-Endocrine Uses
- RA
- Collagen Vascular Disorders
- Gout
- Severe Allergic Rxns
- Fetal Lung Maturation (Betamethasone - Reduces risk of RDS at birth)
Bronchial Asthma Tx
“Best Friend Turned BoyFriend”
- Beclomethasone Diproponate
- Fluticasone
- Triamicinolone Acetonide
- Budesonide
- Flunisolide
Corticosteroids SE
- Peptic Ulcers
- Osteoporosis
- Precipitation of DM and HTN
- Edema
- Glaucoma
- Cataract
- Fetal Abnormalities
- Muscle Wasting
- Immune Responses
- Suppression of HPA Axis
General Principles in Corticosteroid Therapy
- Use short acting, lowest possible dose for short period
- Long Term Tx - HP Suppression
- ABRUPT CESSATION - WITHDRAWAL
- Gradually Taper Off Dose
- Infxn, Severe Stress, trauma = INC THE DOSE (acute adrenal insufficiency)
- Use more locally applicable preparations
Glucocorticoid Antagonists
- Metyrapone - Used in Cushing’s; Suppress CYP11B1
SE: Edema, Hirsutism - Aminoglutethimide - CYP11A1 in Cushing’s; Also used in Breast Cancer
- Trilostane - 3-17 Hydroxysteroid Dehydrogenase Inhibtor
