Mineralocorticoids

Question 1

What is an example of a mineralocorticoid?

Answer 1

• Fludrocortisone

Question 2

What is the method of action of mineralocorticoid?

Answer 2

• Physiological action similar to that of hydrocortisone
• Affects in particular electrolyte balance and carbohydrate metabolism being heightened and prolonged
• Acts on distil tubes of the kidney to ↑ reabsorption of Na ions into plasma
• ↑ urinary excretion of K+ and H+

Question 3

What are the indications for minerocorticoids?

Answer 3

• Addison’s disease – partial replacement for primary and secondary adenocrotical insufficiency
• Treatment of salt losing adrenogenital syndrome

Question 4

What are the contraindications for mineralocorticoids?

Answer 4

• Suffering from chicken pox/shingles for the first time
• Suffering from an infection and not taking any prescribed medication
• Peptic ulcer
• Active TB
• Pyschosis
• Recent bacterial, viral or fungal infection – caution
• History of TB – caution
• Bowel disorder – caution
• Thrombophlebitis – caution
• History of mental disorder/epilepsy – caution
• Kidney, liver or thyroid problem – caution
• Recently suffered from cancer – caution
• Osteoporosis – caution
• Myasthenia gravis – caution
• High blood pressure – caution
• Heart failure – caution
• Glaucoma (inc. family history) – caution
• Diabetic (inc. family history) – caution as insulin dose may need altering
• Skin rash caused by viral infection e.g. measles – caution
• Muscle damage caused by steroid cream – caution
• Over 65 – caution as may be more susceptible to side effects
• Under 18 – caution as may slow down your growth
• Suffering from stress – caution as may need to increase duration of treatment

Question 5

What are the side effects of mineralocorticoids?

Answer 5

• Mood changes – depression or mania, suicidal thoughts, anxiety
• Insomnia
• Confusion, delusions, hallucinations
• ↑ chance of infections
• Fluid retention
• Cardiac arrhythmias
• GI upset
• Candidiasis
• Osteoporosis
• Limb weakness
• ‘Moon face’
• Menstrual irregularities

Question 6

What drugs do mineralocorticoids interact with?

Answer 6

• NSAIDs - ↑ chance of bleeding in the gut
• Antifungals (ketoconazole etc.) - ↓ metabolic clearance of fludrocortisone
• Anticoagulants - ↓ affect
• OCP/HRT – corticosteroid half like and concentration ↑
• Human growth hormone – growth promotion may be inhibited
• Muscle relaxants eg. Atracurium
• Cyclosporin - ↑ = toxicity
• Barbiturates - ↑ metabolic clearance of fludrocortisone
• Any hypertensive medication e.g. ACE inhibitors, beta blockers etc. - ↓ affect
• Digoxin - ↑ = toxicity
• Anti-epileptic drugs e.g. phenytoin, carbamazepine - ↑ metabolic clearance of fludrocortisone
• Anit-TB drugs e.g. rifampicin – serum concentration ↓
• Anti-diabetic drugs - ↑ blood glucose
• Cushing syndrome medications e.g. aminoglutethiamide - ↑ metabolic clearance of fludrocortisone
• Glaucoma medication e.g. acetazolamide
• Hyoscine
• Asthma and COPD medications e.g. tiotropium – affect ↑
• Urinary retention medication e.g. doxazosin
• Alzheimer’s dementia e.g. donepezil
• Myasthenia Gravis e.g. neostigmine
• Vaccinations - neurological complications and lack of antibody response

Question 7

What organ eliminates mineralocorticoids?

Answer 7

Kidney

Question 8

What should a patient taking mineralocorticoids be told?

Answer 8

• If you take this medication for over 3 weeks, then you receive a blue steroid card – always keep this with you and show it to any healthcare professional treating you
• Do not stop taking medication abruptly