Chapter 28: Adrenal Cortex

Question 1

What glucocorticoid receptor agonists are available in an inhaled form? What are these used to treat?

Answer 1

FB FB T (fluticasone, beclomethsone, flunisolide, triamclinolone, budeosonide)

Chronic asthma

Question 2

What glucocorticoid receptor agonists are used cutaneously for things like psoriasis and dermatitis?

Answer 2

Methylprednisolone
Dexamethasone
Hydrocortisone

Question 3

Which glucocorticoid receptor agonist has a long duration of action?

Answer 3

Dexamethasone

D is for Duration

Question 4

What is the relationship between glucocorticoid anti inflammatory potency and duration of action?

Answer 4

The greater the anti-inflammatory potency the longer the duration of action

Question 5

What do you need to keep in mind when switching a patient from oral glucocorticoids to inhaled?

Answer 5

Do not switch abruptly - wean off, especially if oral is high dose.

Question 6

Administering glucocorticoids can lead to what major adverse effects?

Answer 6

Osteoporosis (because of decreased osteoblast activity)

Hypercortisolism w/ Cushing-like symptoms

Growth retardation

Diabetes mellitus

Question 7

What is a negative effect of inhaled glucocorticoids? How can you advise a patient to avoid this?

Answer 7

Oropharyngeal candidiasis

Rinse mouth with water thoroughly after each use

Think of your symbicort

Question 8

Which glucocorticoid can be administered to a pregnant woman without affecting the baby?

Answer 8

Prenisone

P is for Pregnant

Question 9

Which glucocorticoid would you prescribe to promote fetal lung development? (i.e. which will cross placental barrier..?)

Answer 9

Dexamethasone

Question 10

Intra-articular glucocorticoid depots are used to treat what types of conditions?

Answer 10

Gout, arthritis

Question 11

Mifepristone is used for what?

Answer 11

Abortion through day 49 of pregnancy

Question 12

How does the MOA of mifepristone differ at low versus high doses?

Answer 12

Progesterone receptor antagonist

Higher concentrations: blocks glucocorticoid receptor (could then be used for ridiculously high ACTH levels…)

Question 13

Mitotane MOA

Answer 13

Structural DDT analogue

Toxic to adrenocortical mitochondria!!! AHHHH kills that mito MITO-tane

Question 14

What is mitotane used for?

Answer 14

Medical adrenalectomy in severe Cushing’s or adenocortical carcinoma…

Because it is toxic to the adrenocortical mitochondria, mitotane will destroy that shit …
so too much cortisol or ACTH? BAM.

Question 15

Why can mitotane cause hypercholesterolemia?

Answer 15

Because mitotane may also inhibit cholesterol oxidase = buildup of cholesterol

Question 16

What drug would you use to treat Cushing’s syndrome in DOGS only?

Answer 16

Trilostane (inhibits 3B hydroxysteroid dehydrogenase)

Question 17

What drug inhibits side-chain cleavage enzyme as well as aromatase - and is used to treat Cushing’s syndrome?

Answer 17

Aminoglutethimide

Question 18

Which drug is used for diagnostic evaluation of the hypothalamic-pituitary-adrenal axis? What is the MOA?

Answer 18

Metyrapone

Inhibits 11B hydroxylation –> impaired cortisol and aldosterone synthesis

Question 19

Ketoconazole

Answer 19

Antifungal agent that generally inhibits the wide range of adrenocortical hormones

Question 20

What is Fludrocortisone?

Answer 20

Mineralcorticoid receptor agonist - like aldosterone

But we use this instead of aldosterone because fludrocortisone has a minimal first pass metabolism

Flud–>Fluid–>aldosterone

Question 21

What do we use fludrocortisone for?

Answer 21

hypoaldosteronism - not enough aldosterone? give this crap!

Question 22

When would we want to use mineralcorticoid receptor ANTAGONISTS?

Answer 22

antagonists would inhibit aldosterone action so that we didn’t retain so much Na and Water….so this would DECREASE BP

Would use in heart failure patients as antihypertensive agents!

Question 23

Spironolactone MOA

Answer 23

mineralcorticoid receptor antagonist

Question 24

Eplerenone MOA

Answer 24

mineralcorticoid receptor antagonist

Question 25

Advair is _____ and Symbicort is ______

Answer 25

Fluticasone

Budesonide