Adrenal Pharmacology

Question 1

Aldosterone acts on the ___ cells in the kidney

Answer 1

principal

Question 2

Spironolactone is a ___ antagonist with side effects on__ and __ receptors

Answer 2

mineralocorticoid; androgen; progesterone

Question 3

3 contraindications of Spironolactone- (think)

Answer 3

Renal insufficiency, pregnancy, hyperkalemia

Question 4

Eplerenone is __ selective, same mechanism as spironolactone

Answer 4

more

Question 5

Amiloride is __ sparing with ___ weak effect

Answer 5

potassium, diuretic

Question 6

Mineralocorticoids will cause ___ in men

Answer 6

gynecomastia

Question 7

__ deficiency should be treated with fludrocortisone, which is a ___

Answer 7

adrenal, synthetic mineralocorticoid

Question 8

Side effects of fludrocortisone

Answer 8

hypertension, hypokalemia

Question 9

Ask patients on fludrocortisone about ___ and __ cravings

Answer 9

presyncope, salt

Question 10

Patients on fludrocortisone should get their _ bp checked

Answer 10

orthostatic

Question 11

First line treatment of hypercortisol levels

Answer 11

surgical adrenalectomy or transsphenoidal pituitary surgery

Question 12

Second line medical treatment of hypercortisol levels which blocks downstream effects of ___

Answer 12

RU-486 (mifepristone); cortisol

Question 13

Metyrapone inhibits enzymes in the ___ pathway

Answer 13

steroidogenesis

Question 14

__ and __ analogs block pituitary adenomas

Answer 14

Somatostatin, Dopamine

Question 15

Pasireotide is a __ analog and can ___ the adenoma

Answer 15

somatostatin; shrink

Question 16

Pasireotide side effects (3)

Answer 16

High glucose, cardiac conduction, gallstones

Question 17

A cytotoxic adrenal enzyme inhibitor

Answer 17

mitotane

Question 18

Can’t use 24 hour UFC with

Answer 18

mifepristone

Question 19

When treating hypercortisolism, look for __ energy and improved __ (diet)

Answer 19

increased; appetite

Question 20

Secondary adrenal insufficiency is only a __ deficiency while primary is both __ and ___ deficiency

Answer 20

glucocorticoid; mineralocorticoids; glucocorticoids

Question 21

Hydrocortisone has a ___ half life but prednisone and dexamethasone half lives are much longer

Answer 21

physiologic

Question 22

Patients on Hydrocortisone should ___ their dose when they are sick

Answer 22

increase

Question 23

High dose hydrocortisone can overwhelm the ___ and act as a ___- therefore patients in crisis with primary adrenal insufficiency can not take their

Answer 23

cortisol-cortisone; aldosterone; mineralocorticoid replacement

Question 24

Explain metyrapone testing for secondary adrenal insufficiency

Answer 24

Give metyrapone to block cortisol production- see if precursor goes up- if it does, ACTH is working and its not SAI. If it doesn’t, then it IS SAI

Question 25

Check for ___ when giving high dose glucocorticoids (over __ mg)

Answer 25

iatrogenic cushings; 60

Question 26

Physiological dose of hydrocortisone- _ mg
Outpatient sick dose __ mg
Shock dose ___ mg

Answer 26

10; 50; 100