Renal/Endocrine/Resp Drugs

Question 0

Glipizide

Answer 0

(Glucotrol)
Sulphonylureas
Insulin secretagogue
Short-acting, admin. w/ meal
Cause NIDDM to IDDDM

Question 1

Humulin

Answer 1

Short-acting insulin

Question 2

Glyburide

Answer 2

(DiaBeta)
Sulphonylureas
Insulin secretagogue
Short-acting, admin. w/ meal
Cause NIDDM to IDDDM

Question 3

Drugs acting on adrenal cortex

Answer 3

Ketoconazole
Mitotane
Trilostane

Question 4

Drugs acting on Hypo-Pit-Adrenal axis

Answer 4

Selegiline

Peroglide

Question 5

Layers of Adrenal cortex

Answer 5

GFR = Z. Glomerulosa, Z. Fasciculata, Z. Reticularis
Functions (respectively) = Salt, Sugar, Sex

Medulla = catecholamines = NE, Epi

Question 6

Mitotane

Answer 6

(Lysodren)... also in DDD
Adrenocorticolytic
Selective necrosis of Z. Fasciculata and Reticularis = partial corticolysis
Used mostly Pituitary-dependent
Use in Adrenal-dependent if inoperable

Question 7

Mitotane adverse effects

Answer 7

Adrenal deficiency (destroys too much)
Relapse

Question 8

Trilostane

Answer 8

(Vetoryl)
Blocks enzyme (hydroxysteroid hydrogenase) = prevents conversion or pregnenalone to progesterone = inhibiting mineralcort., glucortic., androgen production
Good for = PD-HAC, FAT

Question 9

Trilostane adverse effects

Answer 9

Limited

Question 10

Ketoconazole

Answer 10

P450 cytochrome oxidase inhibitor = inhibits glucocort., androgens
Not as good as mitotane or trilostane = used only when these two are not effective

Question 11

Ketoconazole adverse effects

Answer 11

Elevated liver enzymes

Anorexia

Question 12

Pars Intermedia HAC, how does it work?
How can you Tx?
Which species is this the most common in?

Answer 12

When have decr secretion of dopamine = incr ACTH
Incr dopamine levels = MAO-B inhibitors, Dopamine-receptor agonists
Horses

Question 13

L-Selegiline

Answer 13

(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

Question 14

Pergolide

Answer 14

(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

Question 15

Hypoadrenocorticism, 3 primary causes, 1 secondary cause

Answer 15

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

Question 16

Tx of acute hypoadrenocorticism?
What are you correcting?
3 drugs you can use?

Answer 16

Rehydrate, correct electrolytes = hypovolemia, hypoNa, hypoK
Glucocorticoids
1. Dexamethasone
2. Prednisolone Na
3. Hydrocortisone
…. Mineralcorticoids are usually not needed for acute crisis

Question 17

Drugs for chronic Addison’s? 2 main drugs

White type of drugs are usually not necessary?

Answer 17

Desoxycosterone pivalate (Percorten V) = mineralcorticoid only
Fludrocortisone acetate (Florinef) = mixed, mineralcorticoid mostly

Glucocorticoids

• not needed with Fludrocortisone
• usually needed with Desoxycosteron pivalate

Question 18

Desoxycosterone pivalate

Answer 18

(Percorten V)
Tx of Chronic Addison’s
Mineralcorticoids only
Daily injections, dogs

Question 19

Fludrocortisone acetate

Answer 19

(Florinef)
Tx Chronic Addion's
Mixed, but mineralcorticoids mostly
Monitor serum electrolytes
Iatrogenic hyperaddrenocorticisim possible