Pharmacology Final

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Pharmacology Final
2011-04-26 12:39:59

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  1. Principle steroid with mineralocorticoid activity is
  2. mineralocorticoid receptor binds aldosterone and cortisol with
    equal affinity
  3. Mineralocorticoids are critical in regulating
    concentrations of minerals, mainly potassium and sodium in extracellular fluids
  4. Loss of aldosterone hormones leads rapidly to
    life threatening abnormalities in electrolye and fluid balance
  5. Major target of aldosterone is in the ___ where it stimulates ___.
    distal tubule of the kidney where it stimulates exchange of sodium and potassium
  6. Primary physiologic effects of aldosterone
    • increased resorption of sodium
    • increased resorption of water
    • increased renal excretion of potassium
  7. two most significant regulators of aldosterone secretion
    • increases in concentration of potassium ions in extracellular fluids
    • angiotensin II
  8. Other factors which stimulate aldosterone secretion
    • adrenocorticotrophic hormone
    • sodium deficiency
  9. Factors which suppress aldosterone secretion
    • atrial naturetic hormone
    • high sodium concentrations
    • potassium deficiency
  10. A deficiency in aldosterone can occur in conjunction with
    hypoadrenocorticism or addison's disease
  11. A lack of aldosterone is lethal due to
    electrolyte imbalances and resulting hypotension and cardiac failure
  12. Fludrocortisone Acetate
    • synthetic adrenocortical steroid
    • high glucocorticoid activity
  13. MoA of fludrocortisone
    • similar to hydrocortisone
    • binds mineralocorticoid receptor
    • binding results in increases in ion and water transport and thus raises extracellular fluid volume and blood pressure
    • potassium levels are lowered
  14. Indication for fludrocortisone
    • partial replacement therapy for adrenocortical insufficiency in Addison's disease
    • treatment of salt-losing adrenogenital syndrome
  15. Contraindications for fludrocortisone
    pt with systemic fungal infections
  16. Drug interactions with Fludrocortisone
    • ampho B or potassium depleting diuretics
    • digitalis (because of K+ changes)
    • oral anticoagulants
    • Anti-diabetic drugs
    • CYP inducers increase secretion of fludrocortisone
  17. Fludrocortisone toxicity
    • irritation
    • cardiac edema
    • increased blood volume
    • HTN
    • effects on e- balance and carb metabolism are heigtened and prolonged b/c it is synthetic
  18. Mineralocorticoid antagonist
  19. Spironolactone MoA
    synthetic steroid that acts as a competitive antagonist to aldosterone and prevents binding
  20. Spironolactone metabolism
    • extensive hepatic metabolism
    • not good for pt with hepatic damage
  21. Spironolactone kinetics
    • slow onset of action
    • requires several days to achieve therapeutic effect
  22. Clinical indications for spironolactone
    • mineralcorticoid excess due to hypersecretion
    • conn's syndrome
    • extopic ACTH production
  23. Toxicity with spironolactone
    • hyperkalemia
    • kidney stones
    • gynecomastia
    • metabolic acidosis
    • acute renal failure
  24. Contraindications for spironolactone
    • oral K+ administration
    • impaired hepatic function
    • Chronic renal insufficiency