Adrenal Pharmacology Flashcards Preview

Endocrine > Adrenal Pharmacology > Flashcards

Flashcards in Adrenal Pharmacology Deck (40)
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1
Q

Causes of hyperaldosteronism

A

Primary, Secondary (cirrhosis, heart failure), Liddle’s, deoxycorticosterone mediated, Licorice

2
Q

Liddle’s Syndrome

A

mutation in epithelial sodium channel leading to hyperaldosteronism

3
Q

Tx for hyperaldosteronism

A

correct underlying cause, adrenalectomy, medications

4
Q

Amiloride/midamore

A

K+ sparing diuretic that blocks ENaC and inhibits sodium reabsorptin into distal tubules

5
Q

Spironolactone/adlactone

A

decrease action of mineralocorticoids –> prevent binding of aldosterone to mineralocorticoid receptor –> reduced upregulation of ENaC, K+ channel, and sodium/potassium pump

6
Q

Eplerenone/Inspra

A

decrease action of mineralocorticoids –> prevent binding of aldosterone to mineralocorticoid receptor –> reduced upregulation of ENaC, K+ channel, and sodium/potassium pump

7
Q

T/F spirinolactone can also bind androgen and progesterone receptors

A

T

8
Q

Indications for spirinolactone

A

primary hyperaldosteronism, PCOS/hirsutism (b/c of non specific action), K+ sparing diuretic: essential hypertension, CHF, cirrhosis, hephrosis

9
Q

Adverse effects of spirinolactone

A

hyperkalemia, volume depletion, gynecomastia, impaired libido, impotence, menstrual irregularities, teratogenic

10
Q

Contraindications for spirinolactone

A

renal impairement, hyperkalemia, pregnancy

11
Q

T/F Eplerenone can also bind androgen and progesterone receptors

A

F –> more specific than spirinolactone

12
Q

Indications for Eplerenone

A

potassium sparing diuretic, primary hyperaldosteronism

13
Q

Contraindications for Eplerenone

A

renal impairement, hyperkalemia, pregnancy

14
Q

Contraindications for Amiloride

A

renal impairement, hyperkalemia

15
Q

What do we monitor when tx hyperaldosteronism?

A

dehydration, bp, serum electrolytes, gynecomastia

16
Q

Causes of mineralocorticoid deficiency

A

primary adrenal insufficiency, hyporeninemia (diabetic nephropathy),

17
Q

Serum state of mineralocorticoid deficiency

A

high K, low Na, low volume

18
Q

Tx of mineralocorticoid

A

replacement and fludrocortisone (Florinef)

19
Q

Fludrocortisone

A

syntehtic mineralocorticoid –> maintain volume and control hyperkalemia

20
Q

Side effects of Fludrocortisone

A

hypokalemia, volume overload

21
Q

Hypercortisolemia causes

A

ACTH dependent: pituitary adenoma, ectopic
ACTH independent: adrenocortical adenoma, bilateral adrenal hyperplasia
Iatrogenic or surreptitious

22
Q

Tx of Hypercortisolemia

A

correct underlying cause/surgery, medical tx is second line –> adrenal cytotoxic, decrease action of glucocorticoids, decrease glucorticoid production

23
Q

Mifepristone tx of Hypercortisolemia

A

antagonist for glucocorticoid receptors –> hard to monitor effects

24
Q

Mitotane tx of Hypercortisolemia

A

adrenal cytotoxic

25
Q

Drugs that inhibit steroidogenesis for hypercortisolemia

A

metyrapone, ketoconazole, aminoglutethimide, etomidate

26
Q

Drugs that inhibit ACTH secretion for hypercortisolemia

A

pasireotide (somatostatin analog), cabergolien

27
Q

T/F pituitary adenomas express somatostatin and dopamine receptors

A

T –> can use pasireotide and cabergolinea s Tx

28
Q

Pasireotide MOA

A

binds somatostatin receptor –> reduced cAMP –> decrease POMC –> decrease ACTH secretion + increased apoptosis/decreased cell growth via PTPase activation

29
Q

Pasireotide side effects

A

hyperglycemia, cardiac conduction, gallstones

30
Q

Enzyme blocked by metyrapone, ketoconazole, mitotane

A

11beta hydroxylase –> 11 deoxycortisol to cortisol

31
Q

Enzymes blocked by ketoconazole

A

1 alpha, 3beta, 11beta –> nonspecific in steroidogenesis pathway

32
Q

T/F somatostatin and dopamine analogs can be used to treat both acth dependent/independent hypercortisolemia

A

F –> work on pituitary so only ACTH dependent

33
Q

T/F ketoconazole can increase liver function tests

A

T –> must monitor LFT

34
Q

Why does secondary adrenal insufficiency only affect glucocorticoids but primary adrenal insufficiency affects both glucocorticoids and mineralocorticoids?

A

If adrenal is not working, cannot have cortisol or aldosterone; if pituitary ACTH is not available, cortisol will not be produced but angiotensin II and potassium can stimulate aldosterone production

35
Q

Tx of glucocorticoid deficiency

A

hydrocortisone, prednisone, dexamethasone

36
Q

Sick day replacement

A

outpt with fever/illness –> double or triple daily dose

37
Q

Stress dose replacement

A

for inpatient illness/perioperative: IV or PO

38
Q

Acute dose replacement for shock/adrenal crisis

A

IV –> taper down when appropriate

39
Q

T/F at doses greater than 60-80mg daily, hydrocortisone has mineralocorticoid activity

A

T –> can overwhelm 11beta hsd2 shunt in aldosterone sensitive tissues like kidney –> excess hydrocortisone can bind and activate MCR –> dont need to supplement MC until HC <60-80

40
Q

Metyrapone test for secondary adrenal insufficiency

A

to distinguish betwn primary/secondary insufficiency after cosyntropin –> metyrapone blocks cortisol production (11 beta hydroxylase)–> low cortisol should stimulate ACTH to restart cortisol production// if normal, ACTH will result in buildup of cortisol precursor: 11 deoxycortisol // if secondary insufficiency, ACTH will not start up –> no buildup of 11 deoxycortisol