Adrenal and Bone

Question 1

Mineralocorticoids

Aldosterone

Answer 1

regulates sodium and potassium absorption in collecting tubules

Question 2

Examples of Glucocorticoids

Answer 2

cortisol
prednisone
dexamethasone

Question 3

Metabolic Effects of Glucocorticoids

Answer 3

stim gluconeogenesis
decrease muscle mass
osteoporosis and decreased growth

Question 4

Anti-Inflammatory Effects of Glucocorticoids

Answer 4

inhibits PLA2, COX2, IL2, IL3, PAF

Question 5

Immunosuppressive Effects

Answer 5

inhibit cell mediated response

for organ transplants

Question 6

Examples of Mineralocorticoids

Answer 6

aldosterone

fludrocortisone

Question 7

Effects of Mineralocorticoids

Answer 7

increases sodium transfer through sodium channels in collecting ducts of kidney

Question 8

Excess Mineralocorticoids

Answer 8

metabolic alkalosis

increases hypertension

Question 9

Deficiencies of Adrenocortical Hormones

Answer 9

increased ACTH and adrenal hyperplasia

Question 10

Tx for Addison’s Disease

Chronic Adrenal Insufficiency

Answer 10

20-30mg of hydrocortisone QD

supplement with fludrocortisone

Question 11

Tx for Acute Adrenal Insufficiency

Answer 11

immediate tx of hydrocortisone

100mg IV every 8 hours

Question 12

Cushing’s Syndrome

Answer 12

from adrenal hyperplasia from tumor

Question 13

Signs/ Symptoms of Cushing’s Syndrome

Answer 13

rounded, trunk obesity, muscle wasting, purple striae, moon face, osteoporosis

Question 14

Treatment of Cushing’s Syndrome

Answer 14

remove tumor

300mg hydrocortisone QD on day of surgery, reduced over time

Question 15

Ketoconazole MOA

Answer 15

inhibits 17a- hydroxylase

blocks synthesis of androgens and cortisol

Question 16

Use of Ketoconazole

Answer 16

fungal infections

rapid reduction of testosterone levels in prostate cancer treatment

Question 17

SE of Ketoconazole

Answer 17

hepatotoxicity

menstrual irregularities, gynecomastia, decreased libido, impotence

Question 18

MOA Spironolactone

Answer 18

aldosterone receptor blockers

androgen receptor bocker

Question 19

Therapeutic Use of Spironolactone

Answer 19

CHF
hyperaldosteronism
female hirsutism

Question 20

SE of Spironolactone

Answer 20

hyperkalemia
acidosis
gynecomastia, menstrual irregularities

Question 21

Normal Plasma Levels of Calcium

Answer 21

8.5-10.4 mg/dl

Question 22

Phosphate

Answer 22

important in intermediary and energy metabolism- making ATP

80% in bone, 15% in soft tissue

Question 23

Vitamin D Synthesis

Answer 23

in skin from 7-dehydrocholesterol under UV light

Question 24

Cholecalciferol

Answer 24

natural form, obtained from diet

Vit D3

Question 25

Ergocalciferol

Answer 25

plant form, obtained from diet | Vit D2

Question 26

Calcitriol | 1,25- dihydroxyvitamin D

Answer 26

biologically active metabolite of Vit D

Question 27

Parathyroid Hormone

Answer 27

increases Ca and Vit D Ca | decreases calcitonin ca

Question 28

Osteoporosis

Answer 28

low bone density impaired bone architecture poor bone strength

Question 29

RANKL

Answer 29

precursor for osteoclasts | increased with excess glucocorticoids

Question 30

Signs of Osteoporosis

Answer 30

kyphosis | lordosis

Question 31

Postmenopausal Osteoporosis

Answer 31

loss in ovarian hormone production- estrogen loss estrogen increases Ca excretion and decreases Ca absorption lost bone density

Question 32

Alendronate, Risedronate MOA

Answer 32

inhibits bone resorption | decreases osteoclast maturation, number, life span

Question 33

Use of Alendronate, Risedronate

Answer 33

drug of choice for osteoporosis, hypercalcemia

Question 34

SE of Alendronate, Risedronate

Answer 34

esophageal irritation, esophagitis, heartburn | osteonecrosis of jaw

Question 35

Denosumab

Answer 35

inhibits RANKL | treatment of osteoporosis in women and men at high risk of fracture

Question 36

MOA of Denosumab

Answer 36

blocks RANKL from binding its receptor | stopping osteoclastogenesis and increases osteoclast apoptosis

Question 37

SE of Denosumab

Answer 37

infections of bone, muscle, joints

Question 38

MOA of Raloxifene

Answer 38

partial agonist at estrogen receptors

Question 39

Use of Raloxifene

Answer 39

stabilizes and increases bone mineral density | tx and prevention of osteoporosis

Question 40

SE of Raloxifene

Answer 40

hot flushes and increases risk of venous thrombosis