Renal/Endocrine/Resp Drugs Flashcards
Glipizide
(Glucotrol) Sulphonylureas Insulin secretagogue Short-acting, admin. w/ meal Cause NIDDM to IDDDM
Humulin
Short-acting insulin
Glyburide
(DiaBeta) Sulphonylureas Insulin secretagogue Short-acting, admin. w/ meal Cause NIDDM to IDDDM
Drugs acting on adrenal cortex
Ketoconazole
Mitotane
Trilostane
Drugs acting on Hypo-Pit-Adrenal axis
Selegiline
Peroglide
Layers of Adrenal cortex
GFR = Z. Glomerulosa, Z. Fasciculata, Z. Reticularis
Functions (respectively) = Salt, Sugar, Sex
Medulla = catecholamines = NE, Epi
Mitotane
(Lysodren)... also in DDD Adrenocorticolytic Selective necrosis of Z. Fasciculata and Reticularis = partial corticolysis Used mostly Pituitary-dependent Use in Adrenal-dependent if inoperable
Mitotane adverse effects
Adrenal deficiency (destroys too much) Relapse
Trilostane
(Vetoryl) Blocks enzyme (hydroxysteroid hydrogenase) = prevents conversion or pregnenalone to progesterone = inhibiting mineralcort., glucortic., androgen production Good for = PD-HAC, FAT
Trilostane adverse effects
Limited
Ketoconazole
P450 cytochrome oxidase inhibitor = inhibits glucocort., androgens
Not as good as mitotane or trilostane = used only when these two are not effective
Ketoconazole adverse effects
Elevated liver enzymes
Anorexia
Pars Intermedia HAC, how does it work?
How can you Tx?
Which species is this the most common in?
When have decr secretion of dopamine = incr ACTH
Incr dopamine levels = MAO-B inhibitors, Dopamine-receptor agonists
Horses
L-Selegiline
(L-Depreynl, Anipryl)
Acts on Hypo-Pit-Adrenal axis
Approved PDH and cognitive dysfunction in dogs
MAO-B (Monamine Oxidase type B) inhibitors = blocks breakdown of dopamine
Disputed claims of efficacy against PD-HAC
Pergolide
(Prascend)
Dopamine D1,D2 receptor agonists = Stim. receptors (in Intermediate Ant. Pit) = Inhib ACTH
Long-acting (binds for long time)
Equine Cushing’s Dz = Pituitary Pars Intermedia Dysfunction = PPID
Tx for life
Hypoadrenocorticism, 3 primary causes, 1 secondary cause
Primary
1. natural (not common) = idiopathic = autoimmune
2. Drug-induced = mitotane, telostane, etc. (usually spares Z.glomer.)
3. Bilateral adrenalectomy
Secondary
Deficiency of ACTH = Iatrogenic (ex. gluco, progestins Tx), Destructive lesions
Tx of acute hypoadrenocorticism?
What are you correcting?
3 drugs you can use?
Rehydrate, correct electrolytes = hypovolemia, hypoNa, hypoK
Glucocorticoids
1. Dexamethasone
2. Prednisolone Na
3. Hydrocortisone
…. Mineralcorticoids are usually not needed for acute crisis
Drugs for chronic Addison’s? 2 main drugs
White type of drugs are usually not necessary?
Desoxycosterone pivalate (Percorten V) = mineralcorticoid only Fludrocortisone acetate (Florinef) = mixed, mineralcorticoid mostly
Glucocorticoids
- not needed with Fludrocortisone
- usually needed with Desoxycosteron pivalate
Desoxycosterone pivalate
(Percorten V)
Tx of Chronic Addison’s
Mineralcorticoids only
Daily injections, dogs
Fludrocortisone acetate
(Florinef) Tx Chronic Addion's Mixed, but mineralcorticoids mostly Monitor serum electrolytes Iatrogenic hyperaddrenocorticisim possible
