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Endocrine
Adrenal and Miscellaneous Endrocrine drugs
| Question | Answer |
|---|---|
| Cushing's types | iatrogenic due to glucocorticoid drugs; endogenous due to overproduction of ACTH by pituitary adenomas |
| Clinical presentation of Cushings | obesity of trunk, face, neck, abdoment, hypertension, acne, hirsuitism, thin skin, easy bruising, amenorhea, depression, diabetes, osteopenia |
| pathophysiology | hypothalamus release CRH which stimulates the anterior pituitary to release ACTH. Circulating ACTH stimulates the adrenal cortex to produce cortisol |
| Drug therapy of Cushing's | Ketoconazole, Aminoglutethimide, Mitotane, Metyrapone |
| ADRs | ketoconazole causes N/V, headache, hepatotoxicity, impotence; amino causes drowsiness, rash, weakness, hypotension, nausea, loss of papetite, hypothyroidism, and blood dyscrasias |
| DDI's of Ketoconazole | 3A4 inhibitor so cuases increase in cyclosporine, warfarin, cisapride, and triazolam; rifampin decreases ketoconzole |
| monitoring parameters of cushing's | need to monitor cortisol level with mitotane |
| Adrenal insufficiency AKA | Addison's; due to primary adrenocortical deficiency caused by destruction of adrenal cortex and results in glucocorticoid and mineral corticoid deficiency |
| Types of Addison's | autoimmune destruction of adrenal cortex; secondary insufficiency due to cessation of chronic exogenous steroid use |
| clinical presentation of addison's | weight loss, malaise, pain, depression, dehydration, hypotension, hyperkalemia, salt craving |
| diagnosis of addison's | cosyntropin (ACTH) test |
| treatment of addison's | hydrocoritisone, gradual tapering of corticosteroids, fludrocortisone |
| Drug therapy of adrenal insufficiency (most potent to least potent) | Dexa>Beta>Fludro>Methyl=Triam>Prednisolone=Prednisone>Hydrocortisone>Cortisone |
| Patient points | take with food; take before 9 am if possible |
| ADRs of steroid | hypertension, sodium and fluid water retention, atheroschlerosis, insomina, anxiety, depression, psychosis, obesity, hyperglycemia, hypokalemia, amenorrhea, impotence, cataracts, glaucoma, infections, impaired wound healing, leukocytosis, myopathy, osteop |
| DDRI's of steroids | rifampin, NSAIDs, estrogens, ketoconzole, macrolides, insulin/PO antihyperglycemics |
| Miscellaneous drugs to treat Addison's | ACTH, Cosyntropin, Corticotropin |
| Vasopressin MOA | ADH that has vasoconstrictive properties |
| Desmopressin (DDAVP | synethetic peptide of Vasopressin with less vasoconstrictive properties, but increases clotting factor levels |
| indication for Vasopressin | DI, variceal hemorrhages, shock, vent fib |
| indications for DDAVP | nocturnal enuresis, DI, hemophilia A, von Willebrands disease |
| ADRs of Vasopressin | angina, MI, vasoconstriction, hyponaetremia, gangrene, ab cramps, tissue necrosis if extravasation occurs, hypersensitivity |
| ADRs of Desmopressin | ab cramp, headache, flushing, nausea, nasal irritation, vulvar pain, nosebleed, rhinitis, hypersensitivity |
| DDIs of Vasopressin and DDAVP | CBZ, chlorpropamide, pressors |
| Androgens and Anabolic Steroids | testosterone, methyltestosterone, fluoxymesterone, oxymetholone, stanozol, oxandrolone, nandrolone |
Created by:
cytoskeletor
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