Komiskey 10-16-07 Corticosteroids And Mineralocorticoids

Front 1

Treatment of Hypoadrenalism (Addison's Disease)

Back 1

1) Hydrocortisone or cortisone
2) hydrocortisone or cortisone is reduced
3) A mineralocorticoid will then need to be added (fludrocortisone).
4) Prednisone or prednisolone may also be used with concurrent administration of fludrocortisone.

Front 2

a potent steroid with both glucocorticoid and
mineralocorticoid activity. Used mainly for
its mineralocorticoid activity in Addison’s
disease

Back 2

FLUDROCORTISONE

Front 3

fludrocortisone mimics the action of ______ (increased sodium and water absorption, increased potassium excretion)

Back 3

aldosterone

Front 4

______ is predominant stimulus for aldosterone synthesis.

Back 4

Activation of renin-angiotensin system in response to hypovolemia

Front 5

Cushing’s disease, AKA pituitary _____

Back 5

basophilism

Front 6

_____ Syndrome - mutation of the epithelial Na channel causing uncontrolled increased activity

Back 6

Liddle

Front 7

glycyrrhizin and glycyrrhetic acid in _____ cause increased sensitivity to aldosterone

Back 7

licorice

Front 8

licorice consumption contraindicated in patients taking ____ to lower blood pressure.

Back 8

"ACE" inhibitors

Front 9

Initiating event of Secondary Hyperaldosteronism

Back 9

decreased BP

or

decrerased circulating volume

Front 10

licorice inhibs what enzyme converting cortisol to cortisone?

Back 10

11betaHSDII

Front 11

Genetic defects or chemical inhibition of this enzyme (licorice - ____ acid) lead to a pseudo-hyperaldosteronism state characterized by severe hypertension. Due to glucocorticoid hormone saturation of MR --> increases aldo effect.

Back 11

glycyrrhizic

Front 12

Benign tumor of the adrenal cortex
Unilateral
Amenable to surgical cure
causes PRIMARY HYPERALDOSTERONISM

Back 12

Aldosterone producing adenoma (APA or Conn’s Tumor)

Front 13

Bilateral hyperplasia of the zona glomerulosa
Treated medically
causes PRIMARY HYPERALDOSTERONISM

Back 13

Idiopathic hyperaldosteronism

Front 14

TREATMENT OF PRIMARY HYPERALDOSTERONISM:
APA

Back 14

unilateral adrenalectomy

Front 15

TREATMENT OF PRIMARY HYPERALDOSTERONISM:
IHA

Back 15

medical management
Mineralocorticoid receptor (MR) blockers
Spironolactone or eplerenone
Epithelial sodium channel blockers
Amiloride or triamterene
Other antihypertensives as needed

Front 16

2 Mineralocorticoid receptor antagonists drugs are available in the U.S.

Back 16

spironolactone (Aldactone) and eplerenone (Inspra)

Front 17

Mechanism of Action of spironolactone

Back 17

competitive inhibitor of aldosterone in the collecting duct of the renal tubal.

Front 18

Side Effects and Toxicity of spironolactone

Back 18

hyperkalemia (monitoring is required), gynecomastia, menstrual disturbances, GI upset, rashes

Front 19

Drug Interactions of spironolactone

Back 19

Salicylates increase metabolism of spironolactone. Drugs that cause hyperkalemia will exacerbate spironolactone-induced hyperkalemia

Front 20

Potassium-sparing diuretics that Block sodium channels

Back 20

Amiloride; Trimterene

Front 21

SPIRONOLACTONE - ____% is metabolized to canrenone

Back 21

80%

Front 22

Aldosterone analogues:

Fludrocortisone = pure ____

Back 22

agonist

Front 23

Eplerenone (Inspra) = selective aldosterone receptor antagonist

Spironolactone = aldosterone antagonist, not _______

Back 23

selective

Front 24

ACE Inhibitors: Antihypertensives

Contraindications

Back 24

Bilateral renal artery stenosis
Hyperkalemia
Pregnancy

Front 25

Do NSAIDs block Renin release?

Back 25

Yes, by blocking PGE2 and PGI2

Front 26

ACE Inhibitors: 3 groups

Back 26

Sulfhydryl-containing (know this one - Captopril)

Dicarboxyl-containing

Phosphorus-containing : Prodrug

Front 27

Group of Captopril, fentiapril, pivalopril, zofenopril, alacepril

Back 27

Sulfhydryl-containing (know this one)

know captopril

Front 28

Group of Lisinopril, ramipril

Back 28

Dicarboxyl-containing

Front 29

Group of Fosinopril

Back 29

Phosphorus-containing : Prodrug

Front 30

Why caution giving ACEi to old folks

Back 30

ACE Inhibitors-Induced Acute Renal Failure

Front 31

ACE breaks down bradykinin. What is effect of ACEI?

Back 31

Bradykinin no broken down --> vasodilation

Front 32

AT1 receptor blockers contraindications

Back 32

Bilateral renal artery stenosis
Hyperkalemia
Pregnancy

Front 33

AT1 receptor blockers indications

Back 33

ACE inhibitor-associated cough
Diabetic nephropathy -Irbesartan, losartan
Heart failure -valsartan

Front 34

Direct renin inhibitor

Back 34

Aliskiren (Tekturna® )

Front 35

Aliskiren (Tekturna® ) indications

Back 35

Treatment of hypertension, alone or in combination with other antihypertensives

Front 36

Pharmacokinetics of Tekturna

Back 36

Absorption – decreased with a high fat meal
Distribution – steady state in 7-8 days
Metabolism – major enzyme appears to be CYP3A4
Excretion – ~25% appears in urine as parent drug