Adrenal Drugs

Question 1

What is another name for ACTH?

Answer 1

Corticotropin

Question 2

What are the different zone in the adrenal cortex? What do these zones make?

Answer 2

Zona Glomerulosa- mineralcorticoids

Zona fasciculata- glucocorticoids

Zona reticularis- sex hormones/androgens

Question 3

What zone of the adrenal cortex does ACTH work on? What does it cause

Answer 3

Zona fasciculata

Increase release of Cortisol
Increase hypertrophy of adrenal cortex

Question 4

What is the process of increasing cortisol?

Answer 4

Hypo releases CRH which goes to anterior pituitary gland….which releases ACTH which goes to zona fasciculata…which releases cortisol

Question 5

What factors increase CRH?

Answer 5

Low BG
Sleep wake cycle
Stress

Question 6

What time of day is ACTH highest?

Answer 6

Morning

Question 7

What is betamethasone?

Answer 7

Glucocorticoid

Question 8

What is cortisone?

Answer 8

Glucocorticoid

Question 9

What is dexamethasone?

Answer 9

Glucocorticoid

Question 10

What is hydrocortisone?

Answer 10

Glucocorticoid

Question 11

What is methylprednisolone? Route? What formulation is it available in?

Answer 11

Glucocorticoid

SC
IV
Intra-articular/sonovial

Available in long-acting (depot)

Question 12

What is prednisone? Route commonly given at what time? Indication?

Answer 12

Glucocorticoid

PO

Morning to prevent insomnia

Respiratory illness

Question 13

What is prednisolone?

Answer 13

Glucocorticoid

Question 14

What is triamcinolone?

Answer 14

Glucocorticoid

Question 15

What is aldosterone?

Answer 15

Mineralocorticoid

Question 16

What is fludrocortisone? What activity does this type of corticosteroid have?

Answer 16

Mineralocorticoids

Aldosterone
Fludrocortisone

Question 17

What do corticosteroid drugs end in?

Answer 17

-one and -ide

Question 18

What routes do glucocorticoids come in?

Answer 18

Topical
PO
Inhaled
Nasal

Question 19

What is glucocorticoid 4 MOA?

Answer 19

Gluconeogenesis
Protein wasting
Retain Na and H2O
Inhibits PLA2

Question 20

What are indications for glucocorticoids(7)?

Answer 20

Inflammatory conditions
Autoimmune disorders
Allergic conditions
Surfactant production
Organ rejection
Rashes
Addison’s disease

Question 21

What are inflammatory conditions that Tx glucocorticoid?

Answer 21

UC
Shock
Head trauma

Question 22

Why are glucocorticoids used to Tx shock and head trauma?

Answer 22

Keeps blood in blood vessels by decreasing histamine release

Question 23

What are the autoimmune disorders that are Tx w/ glucocorticoids?

Answer 23

RA
MS
MG

Question 24

What is Tx Addison’s disease?

Answer 24

Fludrocortisone

Hydrocortisone

Question 25

What is Addison’s disease? Cause? Sx? Tx drugs?

Answer 25

Decreased mineralcorticoids and glucocorticoids Autoimmunity Dehydration HoTN Hyperpigmentation Fludrocortisone Hydrocortisone

Question 26

What are the two drug categories of glucocorticoids?

Answer 26

Natural steroids | Synthetic steroids

Question 27

What are the 3 differences of synthetic corticosteroids from natural corticosteroids?

Answer 27

More potent Less Na+ retention Longer acting

Question 28

What is important to know about fludrocortisone (Florinef) and hydrocortisone?

Answer 28

Fludrocortisone: mineralcorticoid and a little glucocorticoid activity Hydrocortisone: glucocorticoid with a little mineralcorticoid activity

Question 29

What is the MOA of Glucocorticoids?

Answer 29

Decrease WBC activity Decrease secretion of proinflammatory and vasoactive cytokines Inhibits PLA2

Question 30

What is the difference between Cushing’s syndrome and Cushings disease? ACTH levels? Cortisol levels?

Answer 30

Cushing disease: only caused by a pituitary adenoma Increased ACTH Increased Cortisol Cushing syndrome: caused by anything that increases the release of cortisol and androgens Decreased ACTH Increased Cortisol

Question 31

What are the Sx of a pt w/ Cushing syndrome? What are the Sx d/t?

Answer 31

Cortisol release - DM - moon face - Buffalo hump Androgen release -Hirsutism

Question 32

What is aminoglutethimide(Cytadren) indicated for? MOA? ADR?

Answer 32

Cushing’s syndrome Tx Inhibits glucocorticoid synthesis in the zona fasciculata Increases ALT and AST

Question 33

Why do you not want to discontinue glucocorticoids abruptly? ADR?

Answer 33

Because the drug cortisol has been sending a negative feedback to ACTH, ACTH is very low and needs to be brought back up Severe mental depression Adrenal atrophy

Question 34

Why is it important to taper off glucocorticoid when DC the drug?

Answer 34

Allows ACTH levels to taper back up to higher levels

Question 35

How do mineralcorticoids effect Na/K channels?

Answer 35

Retain Na+ and waste K+ in the DCT

Question 36

What type of pts do you want to be cautious giving a corticosteroid?

Answer 36

``` Ulcers CHF active infection DM Heart issues Child growth ```

Question 37

What is the contraindication for corticosteroids? What can it cause? What risk category is it?

Answer 37

Pregnancy Cleft palate Category C drug

Question 38

Why is giving a corticosteroid to a child who is growing a risk?

Answer 38

Because corticosteroids decrease the release of GH