Pharma L4 Adrenal

Question 1

How does glucocorticoids affect calcium?

Answer 1

It increases excretion and prevents absorption by antagonizing Vitamin D

Question 2

Effect of glucocorticoids on Uric acid

Answer 2

Enhance excretion (gout treatment)

Question 3

Effect on HPA-axis?

Answer 3

Chronic use: suppress ACTH, GH, TSH and LH

Question 4

Explain when Hydrocortisone is given and why?

Answer 4

2/3 of the dose is given in the morning and 1/3 in afternoon to simulate natural secretion

Question 5

How to treat acute Addison’s disease?

Answer 5

Hydrocortisone, mineralocorticoid with 5% dextrose

Question 6

How to prevent adrenocortical crises?

Answer 6

Alternate day: Long acting ACTH, corticosteroids 1-2 weeks before withdrawal

Question 7

Explain the significance of dexamethasone suppression test

Answer 7

Its differentiates between high cortisol due to pituitary causes and high cortisol due to adrenal tumor.
So dexamethasone is given, if cortisol is suppressed its a pituitary cause

Question 8

What is congenital adrenal hyperplasia?

Answer 8

It is genetic deficiency in enzymes that synthesize cortisol with loss of long negative feedback loop leading to high levels of ACTH, which in turn will activate adrenal gland proliferation and synthesis of other hormones like androgens.

Question 9

What effect does cortisol have on the eye ?

Answer 9

Glaucoma

Question 10

Explain the role of glucocorticoids in management of preterm labor

Answer 10

Beclomethasone is given to mothers with anticipated preterm delivery (<34 weeks) in order to enhance surfactant production and avoid Acute respiratory syndrome

Question 11

PKs of Glucocorticoids

Answer 11

1) 90% binds CBG and the rest bind albumin
2) it is conjugated in the liver by glucouronic acid (HL increases in liver dysfunction)
3) They should be given every other day to prevent HPA-axis suppression

Question 12

How long after starting glucocorticoid treatment does adverse events typically manifest?

Answer 12

One week later (time & does dependent correlation)

Question 13

Which types of ADR are associated with glucocorticoid therapy?

Answer 13

Types A,C and E

Question 14

Metyrapine (MOA and its use)

Answer 14

It inhibits 11 beta-hydroxylase hence prevents cortisol formation.
Used in treatment of cushing’s

Question 15

Aminoglutethimide

Answer 15

Prevents conversion of cholesterol into pregnenolone, hence inhibits all steroids.
Used to treat breast cancer

Question 16

Mifepristone (MOA & use)

Answer 16

Long acting blocker of GC and progesterone
Used for pregnancy termination and treatment of cushing’s