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Flashcards in Adrenal Pharm Deck (33):
1

Causes of Hyperaldosteronism (5)

Primary hyperaldosteornism
Secondary: Cirrhosis, heart failure
Liddle's syndrome: mutation in epithelial sodium channel
Deoxycorticosone mediated
Licorice ingestion (pseudohyperaldosteronism)

2

Spionolactone: Action (3)

Mineralocorticoid antagonist
Also blocks androgen, progesterone receptors

3

Spriconolactone: Uses (3)

Potassium sparing diuretic (HTN, CHF, cirrhosis, nephrosis)
Primary hyperaldosteronism
PCOS/hirsutism

4

Spironolactone: AE (5)

Hyperkalemia
Volume depletion
Gynecomastia/impaired libido in men
Menstrual irregularities
Teratogenic

5

Spironolactone: CI (3)

Renal impairment
Hyperkalemia
Pregnancy

6

What is action of eplerenone?

Highly selective mineralocorticoid antagonist

7

Eplerenone: uses (2)

Potassium sparing diuretic
Primary hyperaldosteronism

8

Eplerenone: CI (3)

Renal impairment
Hyperkalemia
Pregnancy

9

Amiloride: Action

Potassium sparing diuretic
Weak diuretic and weak antihypertensive

10

Amiloride: Use

potassium sparing diuretic

11

Amiloride: CI (2)

Renal impairment
Hyperkalemia

12

What things need to be monitored with potassium sparing mineralocorticoid antagonists? (4)

Dehydration
BP
Serum electrolytes
Men: gynecomastia

13

Mineralocorticoid deficiency: Causes (2)

Primary adrenal insufficiency
Hyporeninemia (i.e in diabetic nephropathy)

14

Mineralocorticoid deficiency treatment

Mineralocorticoid replacement: fludrocortisone (florinef)

15

What are side effects of fludrocortisone? (4)

Hypokalemia
Volume overload: edema, HTN, CHF

16

Monitoring fludrocortisone replacement: What are your concerns? (5)

Presyncope, lightheadedness
Salt cravings
Swelling/edema
BP/HR
Monitor Na/K and plasma renin activity

17

Hypercortisolism: Treatment options (5)

Surgical adrenalectomy or hypophysectomy
Mifepristone: glucocorticoid receptor antagonist
Mitotane: Adrenal cytotoxic
Inhibit enyzymes in steroidogenesis: Metyrapone, ketoconazole, aminoglutethimide
Inhibit ACTH secretion: Pasireotide (SS analog)

18

Why does pasireotide work for Cushing's syndrome?

Pituitary adenomas express somatostatin and dopamine receptors...pasireotide is SS analog and suppresses ACTH secretion

19

What are side effects of SS analogs? (3)

Increase in blood glucose levels
Cardiac conduction defects
Gallstones

20

How do adrenal enzyme inhibitors work?

Block steroid synthesis at multiple sites

21

Why can't you check urinary free cortisol in mifepristone treatment?

Because it blocks GCR, but doesn't affect cortisol production

22

For which treatments should you monitor LFTs?

Ketoconazole, pasireotide

23

What are treatments for glucocrticoid deficiency? (3)

Cortisol replacement:
Hydrocortisone (half life=8-12hr)
Dexamethasone (half life=36-54hr)
Presdnisone (18-36hr)

24

Why would you use hydrocortisone over other glucocorticoids?

Best approximates circadian rhythm

25

What are principles of hydrocortisone treatment? (3)

Sick day replacement: double or triple daily dose for days with fever
Stress dose replacement: taper to physiologic dose once stress is relieved
Acute dose for shock/adrenal crisis: Use IV then taper to pays dose

26

What is concern with high doses of hydrocortisone treatment?

It will overwhelm cortisol-cortisone shunt and bind mineralocorticoid receptor-->pseudohyperaldosternism

27

What do we monitor for hydrocortisone replacement? (4)

Fatigue/appetite
BP, weight
Signs of over-replacement (iatrogenic Cushing's)

28

Testing for Primary Adrenal Insufficiency

First check morning cortisol
If low cortisol, do IM cosyntropin stimulation test

29

Testing for Secondary Adrenal Insufficiency

Meyrapone testing:
If observe high levels of 11-deoxycortisol (cortisol precursor) then there is no secondary adrenal insufficiency
If low levels of 11-DOC, then pituitary problem

30

What is enzyme that meyrapone blocks?

11-ß-hydroxylase

31

Monitoring in metyrapone stimulation

Need inpatient monitoring, especially of BP/HR (concern is hypotension)
Terminate test with IV hydrocortisone to restore cortisol levels

32

Use of synthetic glucocorticoids: Which ones do not affect mineralocorticoid receptors (3)

Methyl-prednisone
Triamcinolone (topical/inhaled)
Dexamethasone

33

Main side effect for synthetic glucocorticoid

IATROGENIC CUSHING'S ALL DAY