Unit 5-Steroids

Question 1

Cortisol, Cortisone acetate, hydrocortisone, prednisone, prednisolone, methylprednisolone, triamcinolone, dexamethasone

Mechanism

Answer 1

Binds GR, which regulates expression of genes with many effects on carbohydrate metabolism and immune function

Question 2

Cortisol, Cortisone acetate, hydrocortisone, prednisone, prednisolone, methylprednisolone, triamcinolone, dexamethasone

Side effects

Answer 2

Cushing’s; glucocorticoid-induced osteoporosis; iatrogenic adrenal insufficiency

Question 3

Hydrocortisone

Uses

Answer 3

Chronic primary adrenal insufficiency (maintenance); CAH

Question 4

Prednisone

Uses

Answer 4

CAH

Question 5

Dexamethasone

Uses

Answer 5

Emergency treatment (severe adrenal crisis, PAI); suppression test (Cushing’s); CAH

Question 6

Fludrocortisone

Drug class

Answer 6

Mineralocorticoid

Question 7

Fludrocortisone

Mechanism

Answer 7

Binds aldosterone receptor (AR) which increases Na+K+ATPase expression and increase epithelial sodium channel experession

Question 8

Fludrocortisone

Uses

Answer 8

Chronic primary adrenal insufficiency (maintenance); CAH

Question 9

Fludrocortisone

Side effects

Answer 9

Primary aldosteronism

Question 10

Aminoglutethide

Mechanism

Answer 10

Blocks conversion of cholesterol to pregnenolone

Question 11

Aminoglutethide

Uses

Answer 11

Cushing’s

Question 12

Ketoconazole

Drug class

Answer 12

Anti-fungal imidazole derivitive

Question 13

Ketoconazole

Mechanism

Answer 13

Potent, nonselective inhibitor of adrenal and gonadal steroid synthesis

Question 14

Ketoconazole

Uses

Answer 14

Cushing’s

Question 15

Mitotane

Drug class

Answer 15

DDT insecticide relative

Question 16

Mitotane

Mechanism

Answer 16

Nonselective cytotoxic action on adrenal cortex

Question 17

Mitotane

Uses

Answer 17

Cushing’s

Question 18

Mitotane

Side effects

Answer 18

Bad side effect profile

Question 19

Metyrapone

Mechanism

Answer 19

Relatively selective inhibitor of 11-hydroxylation (interferes with cortisol and corticosterone synthesis)

Question 20

Metyrapone

Uses

Answer 20

Cushing’s

Question 21

Mifepristone (RU-486)

Mechanism

Answer 21

Progesterone receptor antagonist; GR antagonist at high concentrations

Question 22

Mifepristone (RU-486)

Uses

Answer 22

Cushing’s (controls hyperglycemia secondary to hypercortisolism)

Question 23

Mifepristone (RU-486)

Side effects

Answer 23

Fatigue, nausea, headache, hypokalemia, arthralgias

edema and endometrial thickening in women

Question 24

Pasireotide

Drug class

Answer 24

somatostatin analog

Question 25

Pasireotide Mechanism

Answer 25

Binds to somatostatin receptor and blocks release of ACTH from corticotropes

Question 26

Pasireotide Uses

Answer 26

Cushing's

Question 27

Pasireotide Side effects

Answer 27

Hyperglycemia, GI problems

Question 28

Spironolactone Mechanism

Answer 28

Aldosterone receptor antagonist

Question 29

Spironolactone Uses

Answer 29

Primary aldosteronism

Question 30

Spironolactone Side effects

Answer 30

Anti-androgenic

Question 31

Eplerenone Mechanism

Answer 31

Aldosterone receptor antagonist

Question 32

Eplerenone Uses

Answer 32

Primary aldosteronism More specific; less anti-androgenic effect than spironolactone