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Test 9 > Pharm 4 Adrenal > Flashcards

Pharm 4 Adrenal Flashcards

1
Q

5 layers of adrenal gland

A 
Capsule
Zona glomerulosa
Zona fasiculata
Zona reticularis
Medulla
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2
Q

Zona glomerulosa - product, stimulus

A

Mineralocorticoids

-Angiotensin II, K+

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3
Q

Zona fasiculata - product, stimulus

A

Glucocorticoids, Androgens, Estrogens

-ACTH

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4
Q

Zona reticularis - product, stimulus

A

Glucocorticoids, Androgens, Estrogens

-ACTH

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5
Q

Medulla - product, stimulus

A

Epinephrine

-Sympathetic activation

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6
Q

3 Glucocorticoid drugs & duration

A
  • Prednisone - short
  • Triamcinolone - intermediate
  • Dexamethasone - long
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7
Q

Glucocorticoid drug that is salt retaining

A

Prednisone

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8
Q

Glucocorticoid drug - strongest anti-inflammatory

A

Dexamethasone

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9
Q

Glucocorticoid drug - topical

A

Triamcinolone and dexamethasone

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10
Q

Prednisone activity

A

Inactive until hydroxylated to Prednisolone

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11
Q

Endogenous cortisol secretion inhibitors

A

GABA, opioids, cortisol

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12
Q

ACTH

A

Adrenocorticotrophic hormone

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13
Q

ACTH secretion

A

CRH -> POMC (pro-opiomelanocortin)

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14
Q

Adrenal steroid storage

A

None, secreted immediately

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15
Q

-Cosyntropin-

A

Synthetic ACTH

  • Only used to assess hypothalamo-pituitary-adrenal axis
  • No therapeutic use/advantage over corticosteroids
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16
Q

CRH action product

A

POMC

17
Q

CRH diagnostic use

A

Differentiate pituitary and ectopic ACTH hypersecretion

18
Q

Cortisol environmental factors

A

Morning
Light exposure
After meals

19
Q

Factors raising CBG level

A

Pregnancy
Estrogen
Thyroid hormones

20
Q

Cortisol metabolism

A

Hepatic: Cortisol -> Tetrahydrocortisol
Renal: Cortisol -> Cortisone -> Tetrahydrocortisone (liver)

21
Q

Cortisol -receptor complex

A

Binds to GREs (glucocorticoid response elements)

22
Q

Cortisol overall metabolic effect

A

Counter insulin

23
Q

Cortisol specific metabolic effects

A

Increase:

  • Overal catabolism
  • Gluconeogenesis
  • Glycogen synthesis
  • Blood glucose
  • Hormone-sensitive lipase, lipolysis
24
Q

Cortisol inflammatory effects

A

Anti-inflammatory/Immunosuppression

    • Cytokines
    • Capillary permeability (+ vasoconstriction)
    • Leukocyte, lymphocyte responses
25
Q

Cortisol calcium effects

A 
Lower Ca levels
-- Vit. D in the intestine
-- Ca absorption
\++ Ca clearance
\++ Bone resorption
26
Q

Addison’s disease Tx

A
  • Glucocorticoid replacement (daily hydrocortisone)

- Mineralocorticoid replacement

27
Q

Impaired pituitary ACTH secretion Tx

A
  • Glucocorticoid replacement only

- No ACTH or mineralocorticoid replacement

28
Q

Congenital adrenal hyperplasia Tx

A

Due to defective cortisol synthesis, accompanied by elevated ACTH

  • Tx dexamethasone during gestation
  • Tx for acute insufficiency (IV hydrocortisone) after gestation
29
Q

Cushing’s syndrome Dx

A

Dexamethasone suppression test (negative feedback to pituitary ACTH)

30
Q

Recommended administration for glucocorticoids

A

10 days, iatrogenic Cushing’s afterwards

31
Q

High dose glucocorticoid toxicity

A

Mineralocorticoid (HTN) effects

-Concern in heart disease patients

32
Q

Prolonged glucocorticoid toxicity (4)

A
  • Infection
  • Growth stunting
  • Catabolism (myopathy, osteoporosis, cataracts)
  • Adrenal suppression/atrophy
33
Q

-Ketoconazole-

A

Inhibits P450 necessary for steroid synthesis

-Most effective, best tolerated Tx

34
Q

-Metyrapone-

A

Inhibits CYP11B1 (11-hydroxylase) necessary for cortisol synthesis

35
Q

-Mifepristone (RU486)-

A

Antagonist of glucocorticoid-R and progesterone-R

-Tx refractory Cushing’s hyperglycemia

36
Q

-Fludrocortisone-

A

Synthetic aldosterone (salt retaining)

37
Q

Aldosterone stimulus

A
  • Na depletion -> Angiotensin II
  • ACTH
  • Low Na or high K within the adrenal
38
Q

Aldosterone action

A

Increase Na reabsorption in distal tubules, collecting ducts

-Increase K excretion

39
Q

-Spironolactone-

A

Competitive mineralocorticoid-R (aldosterone) antagonist

-Tx primary aldosteronism

Test 9 (17 decks)

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