Physio and Pharm Use of Adrenal Hormones Flashcards Preview

Week 27: Adrenal Dysfunction > Physio and Pharm Use of Adrenal Hormones > Flashcards

Flashcards in Physio and Pharm Use of Adrenal Hormones Deck (18)
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1

Definitions
1. Corticosteroid
2. Glucocorticoids
3. Mineralocorticoids

1. Both GCs and mineralocorticoids (hormones produced in the adrenal cortex)
2. Relating to glucose metabolism (zona fasiculata)
3. Mineral/electrolyte effects (zona glomerulosa)

2

Therapeutic uses of GCs

To establish the diagnosis and cause of Cushing's syndrome
Treatment of adrenal insufficiency using physiologic replacement doses
Treatment of congenital adrenal hyperplasia
Pharmacologic doses for patients with inflammatory, allergic, and immunological disorders

3

Cortisol
1. Inactive form
2. Where is it activated
3. Where it is inactivated
4. What receptors does the active form bind

1. Cortisone
2. Liver
3. Kidney and placenta
4. Both GC and mineralocorticoid receptors

4

Prednisone
1. Active form
2. Where is it activated
3. Where it is inactivated
4. What receptors does the active form bind

1. Prednisolone
2. Liver
3. Kidney and placenta
4. GC >>> mineralocorticoid receptors

5

4 drugs that increase hepatic steroid metabolism

Phenytoin
Barbiturates
Rifampin
Mitotane

6

Routes of admin of GCs

IV
IM
Intra-articular
Orally
Nasal spray
Topically

7

Primary adrenal insufficiency goals of treatment

Trying for physiological replacement
Want the diurnal variation

8

Classic 21 a-hydroxylase deficiency goals of treatment

Reduce the excessive CRH and ACTH to decrease production of adrenal-derived androgens

9

How does illness change GC administration?

3 times usual daily dose for 3 days if can take oral
IV or IM
Monitor because there are no hard and fast rules

10

Treatment for adrenal crisis

If no previous diagnosis (not on steroids), then give them dexamethasone
Known diagnosis = give regular steroids (HC)

11

Anti-inflammatory action

Primary anti-inflam mechanism: inhibit lipocortin-1 synthesis
Inhibit the 2 main inflammatory products prostaglandins and leukotrienes
Used in the treatment of disease caused by overactive immune systems (allergies, asthma, autoimmune diseases)

12

Budesonide

Topical used as an oral preparation
Extended release enhanced topical potency and limits systemic bioavailability
Used in IBD
Extensive first pass hepatic metabolism

13

Which GC is the most potent ACTH suppressor

Desamethasone

14

Complications of chronic GC use

HPA axis suppression (even after ACTH is restored, the hypoplastic adrenal glands may require a lot time to return to normal)
Cushing's syndrome
Myopathy and osteoporosis

15

Why should potent topical GCs be avoided in children under 12?

Larger surface area to body weight ratio
Very sensitive to HPA suppression

16

Escape phenomenon

When the ECF expansion passes a certain point and Na is excreted
No edema in normal individuals with hyperaldosteronism

17

Tapering GC use

First withdrawl GC for 24 hours or replace with equivalent dose of dexa
Perform 8 AM cortisol
Unless is clearly low or clearly normal, need ACTH stim test

18

Fludrocortisone

Synthetic mineralocorticoid
Used in all patients with primary adrenal insufficiency or congenital adrenal hyperplasia