Glucocorticoids and Mineralocorticoids

Question 1

cosyntropin

Answer 1

ACTH replacement

Question 2

hydrocortisone duration of action

Answer 2

short (8-12 hours)

Question 3

methylprednisone duration of action

Answer 3

intermediate (12-36)

Question 4

dexamethasone duration of action

Answer 4

long (36-72)

Question 5

cortisol negative feedback

Answer 5

hippocampus, hypothalamus, pituitary

Question 6

fludrocortisone

Answer 6

primarily mineralocorticoid effects, but has some anti-inflammatory effects

Question 7

when does a patient have a suppressed HPA axis?

Answer 7

HPA is suppressed with supra physiologic doses; if a patient is on GCs prior (<1yr) to surgery, need to supplement because they cannot mount the typical cortisol response

Question 8

mifepristone RU-486 moa

Answer 8

binds with high affinity to GC receptor complex in the nucleus (antagonist)

Question 9

mifepristone RU-486 use

Answer 9

only for patients with ectopic ACTH secretion or adrenal carcinoma who have failed to respond to other therapeutics

Question 10

mifepristone RU-486 adverse effects

Answer 10

vaginal bleeding, abdominal pain, GI (diarrhea), headache

Question 11

spironolactone moa

Answer 11

aldosterone receptor antagonist + weak antagonism of androgen receptors

Question 12

eplerenone

Answer 12

aldosterone receptor antagonist

Question 13

spironolactone and eplerenone adverse effects

Answer 13

hyperkalemia and gynecomastia (spironolactone only)

Question 14

fludrocortisone adverse effects

Answer 14

salt and fluid retention, CHF, sign and symptoms of GC excess