Pharm 4 Adrenal Flashcards Preview

Test 9 > Pharm 4 Adrenal > Flashcards

Flashcards in Pharm 4 Adrenal Deck (39):
1

5 layers of adrenal gland

Capsule
Zona glomerulosa
Zona fasiculata
Zona reticularis
Medulla

2

Zona glomerulosa - product, stimulus

Mineralocorticoids
-Angiotensin II, K+

3

Zona fasiculata - product, stimulus

Glucocorticoids, Androgens, Estrogens
-ACTH

4

Zona reticularis - product, stimulus

Glucocorticoids, Androgens, Estrogens
-ACTH

5

Medulla - product, stimulus

Epinephrine
-Sympathetic activation

6

3 Glucocorticoid drugs & duration

-Prednisone - short
-Triamcinolone - intermediate
-Dexamethasone - long

7

Glucocorticoid drug that is salt retaining

Prednisone

8

Glucocorticoid drug - strongest anti-inflammatory

Dexamethasone

9

Glucocorticoid drug - topical

Triamcinolone and dexamethasone

10

Prednisone activity

Inactive until hydroxylated to Prednisolone

11

Endogenous cortisol secretion inhibitors

GABA, opioids, cortisol

12

ACTH

Adrenocorticotrophic hormone

13

ACTH secretion

CRH -> POMC (pro-opiomelanocortin)

14

Adrenal steroid storage

None, secreted immediately

15

-Cosyntropin-

Synthetic ACTH
-Only used to assess hypothalamo-pituitary-adrenal axis
-No therapeutic use/advantage over corticosteroids

16

CRH action product

POMC

17

CRH diagnostic use

Differentiate pituitary and ectopic ACTH hypersecretion

18

Cortisol environmental factors

Morning
Light exposure
After meals

19

Factors raising CBG level

Pregnancy
Estrogen
Thyroid hormones

20

Cortisol metabolism

Hepatic: Cortisol -> Tetrahydrocortisol
Renal: Cortisol -> Cortisone -> Tetrahydrocortisone (liver)

21

Cortisol -receptor complex

Binds to GREs (glucocorticoid response elements)

22

Cortisol overall metabolic effect

Counter insulin

23

Cortisol specific metabolic effects

Increase:
-Overal catabolism
-Gluconeogenesis
-Glycogen synthesis
-Blood glucose
-Hormone-sensitive lipase, lipolysis

24

Cortisol inflammatory effects

Anti-inflammatory/Immunosuppression
-- Cytokines
-- Capillary permeability (+ vasoconstriction)
-- Leukocyte, lymphocyte responses

25

Cortisol calcium effects

Lower Ca levels
-- Vit. D in the intestine
-- Ca absorption
++ Ca clearance
++ Bone resorption

26

Addison's disease Tx

-Glucocorticoid replacement (daily hydrocortisone)
-Mineralocorticoid replacement

27

Impaired pituitary ACTH secretion Tx

-Glucocorticoid replacement only
-No ACTH or mineralocorticoid replacement

28

Congenital adrenal hyperplasia Tx

Due to defective cortisol synthesis, accompanied by elevated ACTH
-Tx dexamethasone during gestation
-Tx for acute insufficiency (IV hydrocortisone) after gestation

29

Cushing's syndrome Dx

Dexamethasone suppression test (negative feedback to pituitary ACTH)

30

Recommended administration for glucocorticoids

10 days, iatrogenic Cushing's afterwards

31

High dose glucocorticoid toxicity

Mineralocorticoid (HTN) effects
-Concern in heart disease patients

32

Prolonged glucocorticoid toxicity (4)

-Infection
-Growth stunting
-Catabolism (myopathy, osteoporosis, cataracts)
-Adrenal suppression/atrophy

33

-Ketoconazole-

Inhibits P450 necessary for steroid synthesis
-Most effective, best tolerated Tx

34

-Metyrapone-

Inhibits CYP11B1 (11-hydroxylase) necessary for cortisol synthesis

35

-Mifepristone (RU486)-

Antagonist of glucocorticoid-R and progesterone-R
-Tx refractory Cushing's hyperglycemia

36

-Fludrocortisone-

Synthetic aldosterone (salt retaining)

37

Aldosterone stimulus

-Na depletion -> Angiotensin II
-ACTH
-Low Na or high K within the adrenal

38

Aldosterone action

Increase Na reabsorption in distal tubules, collecting ducts
-Increase K excretion

39

-Spironolactone-

Competitive mineralocorticoid-R (aldosterone) antagonist
-Tx primary aldosteronism