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NURS 572 Pharm 59

Pham Ch 59 Adrenal cortex drugs

The adrenal cortex produces three classes of hormones *glucocorticoids (hypothal/pituitary control *mineralocorticoids (RAAS control) *Androgens (hypotha/pit control)
what is the feedback look for glucocorticoids and androgens they feed back to both hypothalamus and pituitary
MOA glucocorticoids (major actions) *CHO metab; increase glucose bwo gluconeogenesis (opposes insulin, worsens diabetes). *pro catabolism (including gluconeogenesis) *fat metabolism (lipolysis, fat redistribution)
MOA glucocorticoids (minor actions) *maintain CV integrity *increase RBCs, neutrophils *DECREASE lymphocytes, monocytes (immunosupp) *CNS maintain mood, excitability *neonatal lung maturity
name the 4 glucocorticoids that also have mineralcorticoid action - from strong dose to weak dose *cortisone *hydrocortisone *prednisone *prednisolone
name 4 glucocorticoids WITHOUT mineralcorticoid action - from strong to weak dose *methylprednisolone *triamcinolone *betamethasone *dexamethasone
name 1 mineralcorticoid aldosterone
MOA of mineralcorticoid - aldosterone maintain Na/H20 and K balance (in collecting duct, mediated by RAAS)
adrenal hormone disorder - Cushing's too much cortisol, too much aldosterone (?)
adrenal hormone disorder - Addison's too little cortisol, too little aldosterone
how do we treat hyperaldosteronism surgery, or tx with spironolactone or amiloride
how do we treat adrenal insufficiency treat with glucocorticoid that has mineralcorticoid action (so we address both the cortisol and aldosterone components of insufficiency)
so, if I have adrenal insufficiency, what 4 corticosteroids would I administer you would administer the corticosteroids that have mineralcorticoid action *cortisone *hydrocortisone (prednisone/prednisolone have less mineralcorticoid action, so aren't preferred)
But what if my adrenal insufficiency treatment doesn't offer enough mineralcorticoid dosage then need to treat with fludrocortisone
hydrocortisone is preferred to treat adrenal insufficiency. Why? because it has significant mineralcorticoid activity in addition to its glucocorticoid actions
how do we dose hydrocortisone important to dose based on diurnal pattern of endogenous secretion --- 2/3 total dose in a.m., 1/3 total dose in p.m.
ADRs of hydrocortisone *HPA axis suppression --> decreased cortisol, aldosterone *if admin too much, could lead to Cushing's
When is fludrocortisone used used in conjunction with glucocorticoid tx when additional mineralcorticoid action is needed
fludrocortisone indicated for these patients *Addison's *primary hypoaldosteronism *congenital adrenal hyperplasia
ADRs fludrocortisone *Na/H20 retention *edema *HTN *hypokalemia
Created by: lorrelaws