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.pharmocology > Adrenal Gland > Flashcards

Adrenal Gland Flashcards

1
Q

Primary adrenal failure (Hypoadrenocorticism)

A

Dependent on which zones destroyed
Glucocorticoids (cortisol) or mineralocorticoids insufficient

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2
Q

What causes primary adrenal failure

A

Spontaneous
Iatrogenic (mitotane, ketoconazole, trilostane- medication treating hyperadreno)

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3
Q

Secondary hypoadrenocorticism

A

Pituitary failure to secrete ACTH (isolated glucocort. insufficiency)

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4
Q

What causes secondary hypoadrenocorticism

A

Idiopathic (suppression of ACTH)
Neoplasia
Genetic (standard poodles, collies)

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5
Q

T/F: Hypoadrenocorticism is a life threatening condition with mineralcorticoid deficiency and requires immediate life saving intervention

A

TRUE
Maintain Na, K and water balance

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6
Q

CS of hypoadrenocorticism

A

Lacks of gluco: depression, lethargy, anorexia, vomiting
Lack of mineral: collapse and bradyarrhthmias

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7
Q

When is Hypoadrenocorticism glucocorticoid tx required

A

Iatrogenic or spontaneous secondary hypoadren.
Primary addison’s disease without mineral deficiency
↑ with stress, illness, sx, trauma and exercise

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8
Q

How is the glucocorticoid tx given?

A

↓ or discontinuation therapy
↓ to physiologic doses slowly
Over 1-3 weeks

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9
Q

Hypoadrenocorticism glucocorticoid tx

A

Dexamethasone
Prenisolone sodium succinate
Hydrocortisone

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10
Q

Glucocortidoid adverse effects

A

Exogenous admin → adrenal cortisol suppression and atrophy

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11
Q

When is hypoadrenocorticism mineralcorticoid tx needed?

A

Only if aldosterone deficient
Not recommended until Na concentration within reference ranges

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12
Q

Mineralcorticoid replacement for hypoadrenocorticism

A

Fludocortisone (PO QD)
Desoxycorticosterone (IM monthly)

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13
Q

Fludocortisone

A

Ease of dx/ adjusting dose
Daily therapy
Expensive

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14
Q

Side effects of Fludocortisone

A

PU/PD, polyphagia, hair loss, weight gain
↑ prevalence when combined with gluco

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15
Q

Desoxycorticosterone

A

Low adverse effects if used alone
Less common tx failures
Infrequent admin

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16
Q

Desoxycorticosterone adverse effects

A

Missinga dose could be fatal

17
Q

_____________ is considered an addisonian (hypoadrenocorticism) crisis

A

Hyperkalemia

18
Q

Hyperkalemia

A

IVFT (↑ GFR and restores circulating blood vol)
Slow infusion of calcium gluconate (protects mycardium)
Insulin (glucose move into cell wall, K flows)
Dextrose (moves K intracellulary

19
Q

Hypoadrenocorticism tx response

A

Occurs within 1-2 hrs
Cats takes longer
Na deficiency causes renal washout (several days diurese)

20
Q

Pituitary dependent hyperadrenocorticism (cushing’s)/ PDH

A

85% of K9/ feline
Benign tumor secretes ACTH → ↑ release of cortisol from adrenal glands

21
Q

Adrenal dependent hyperadrenocorticism

A

50% benign
Autonomously secretes coritsol

22
Q

CS associated with hyperadrenocorticism

A

PU/PD, polyphagia, skin lesions (thin, non healing), anestrus

23
Q

Goals of hyperadrenocorticism therapy

A

Eliminate hypersecretion of cortisol
Dog: medical managment
Cats: bilateral adrenalectomy (lifelong tx for hypoadren)

24
Q

T/F: no drug will cure PDH

A

TRUE
tx focuses on mediating amount of cortisol present

25
Q

Mitotane (hypoadren) MOA

A

Adrenolytic: causes selective necrosis of zona fasciculate and reticularis (that secrete cortisol and sex hormones)
Specfiic for hyperplastic glands

26
Q

Mitotane induction and maintenance

A

Induction: serum cortisol levels @ normal range
Maintenance: based on dose and duration, depends on ACTH test

27
Q

Mitotane uses

A

Patients with diabetes mellitus
Removes the cause for insulin resistance (hypocalcemia may occur)

28
Q

Adverse effects of mitotane

A

GI: V/D, anorexia
Neurologic: weakness, ataxia
Rapid drop cortisol levels

29
Q

Goal of adrenal dependent hyperadrenocorticism

A

Complete destruction of the tumor tissue in the adrenals
Require high doses and longer induction times
Admin predisone concurrently

30
Q

Trilostane (hyperadren) MOA

A

Synthetic steroid analog that inhibits adreal enzyme production of cortisol and aldosterone

31
Q

Adverse effects of trilostane

A

Mild lethargy and vomiting
Can affect aldosterone → hypoadrenocortisol crisis can occur

32
Q

Ketoconazole (hyperadren) MOA

A

Triazole antifungal
↓ serum cortisol and testosterone

33
Q

Ketoconazole uses

A

Dogs that can’t tolerate mitotane
Limited efficacy and expensivw

.pharmocology (21 decks)

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