4.7 Mineralocorticoids
What are the ADRs of Mineralocorticoids for electrolyte balances, musculoskeletal, dermatologic, GI, and Endocrine?
*Fluid/Electrolyte:* Edema, HTN, CHF, Cardiac Enlargement, Hypokalemic Alkalosis, Potassium loss *Musculoskeletal:* Osteoporosis, Vertebral Compression, Fracturing. Femur/ humeral head necrosis. *Dermatologic:* Interference w/ healing, thin fragile skin, Bruising *GI:* Peptic ulcer w/ Perforation *Endocrine:* Suppression of growth in children, Cushingoid State -- too much Cortisol (overdose, opposite of Addison's), compensatory reduced effects of pituitary, etc.
After taking a mineralocorticoid, a young male patient complains of gynecomastia & sexual dysfunction (which his girlfriend is not too pleased about). What drug would you recommend him switching to? a. Eplerenone b. Spironolactone c. Prednisone d. Mifepristone e. Fludrocortisone [Florinef]
A (Eplerenone lacks spironolactone ADRs of gynecomastia & sexual dysfunction) (*Mnemonic: *EplerNONE has NONE of the sexual side effects of a typical aldosterone agonist).
When large amounts of Mineralocorticoids are taken, which of the following are DECREASED (choose all that apply)? a. adrenocortical secretion b. pituitary corticotrophin secretion c. activity of Thymus d. deposition of liver glycogen e. protein catabolism
ABC
These *direct aldosterone receptor antagonists* in collecting tubules inhibit aldosterone-mediated Na+ reabsorption and K+ secretion. They have been shown to increase survival in pts w/CHF. ADRs include* gynecomastia in male pts due to antiandrogenic properties.* a. Rifampin b. Spironolactone/Eplerenone c. Prednisone/Mifepristone/Methylprednisone d. Mitotane e. Fludrocortisone [Florinef]
B
This *Aldosterone antagonist* is effective in pts with *ascites related to advanced liver disease.* It is also part of standard treatment for *CHF.* a. Eplerenone b. Spironolactone c. Prednisone d. Mifepristone e. Fludrocortisone [Florinef]
B
Which of the following ADRs might be expected with patients taking *Aldosterone antagonists?* a. Hypokalemia and subsequent Metabolic Alkalosis b. Hyperkalemia and subsequent Metabolic Acidosis c. Hypokalemia and subsequent Metabolic Acidosis d. Hyperkalemia and subsequent Metabolic Alkalosis e. Hypernatremia
B (Opposite effects of Aldosterone, which retains Na+ and excretes K+, causing a metabolic alkalosis. By blocking aldosterone, you will save K+ and possibly have a metabolic ACIDosis).
A new elderly male patient complains of *gynecomastia & sexual dysfunction after taking a mineralocorticoid for a heart condition.* He can't seem to remember what drug he was taking or what his heart condition is (unrelated to the drug, but poor guy!). What drug is he on? a. Eplerenone b. Spironolactone c. Prednisone d. Mifepristone e. Fludrocortisone [Florinef]
B (Spironolactone is used in CHF, liver disease, and causes the ADRs described in the prompt. Eplerenone lacks spironolactone ADRs of gynecomastia & sexual dysfunction)
Which drugs have interactions with mineralocorticoids?
Barbiturates Digoxin Furosemide Phenytoin Rifampin*- had this in blue
Would you treat Addison's disease primarily with a mineralocorticoid (i.e. aldosterone) or glucocorticoid (i.e. Prednisone), or both?
Both (Mineralocorticoids primarly b/c Addison's is due to adrenocortical insufficiency, so aldosterone is a replacement therapy) (glucocorticoids b/c of other imbalances, anti-inflammatory)
When large amounts of Mineralocorticoids are taken, which of the following are INCREASED (choose all that apply)? a. adrenocortical secretion b. pituitary corticotrophin secretion c. activity of Thymus d. deposition of liver glycogen e. protein catabolism
D, E- except with adequate protein intake
This is a synthetic drug that is generally *similar to hydrocortisone* but it has very powerful *mineralocorticoid actions*. It is really on used in therapy only for mineralocorticoid actions a. Mifepristone b. Rifampin c. Prednisone d. Mitotane e. Fludrocortisone [Florinef]
E
Which drug would you preferentially give a patient with* Addison's?* a. Mifepristone b. Rifampin c. Prednisone d. Mitotane e. Fludrocortisone [Florinef]
E (mineralocorticoid to address adrenal insufficiency) A- Cushing's B- TB C- various D.- inoperable cortical carcinoma
At LARGE DOSES, this drug has a compensatory feedback (inhibition of adrenal cortical secretions, pituitary corticotrophin excretion, and thymus activity). It may induce *negative nitrogen balance so protein is broken down.* a. Mifepristone b. Rifampin c. Prednisone d. Mitotane e. Fludrocortisone [Florinef]
E. Also increase deposition of liver glycogen.
Mineralocorticoid secretion is controlled primarily by these two systems:
K+ concentration excretion Renin-Angiotensin System (RAAS)
Mineralocorticoids like aldosterone promote Na+ ____ and K+ ___ (Choose 2 from filtration, reabsorption, secretion, or excretion)
Na- reabsorption K-excretion (mineralocorticoids = SALT, wants to reabsorb as much salt and get rid of other stuff)
What are the major ADRs related to H20 & Na+ retention in Mineralocorticoids:
a. Edema + Hypertension (b/c of Na+ retained) b. CHF + Cardiac enlargement (b/c increased BP, heart expands) c. K+ loss (b/c Ca+ retained) --> *Hypokalemic alkalosis* (aldosterone causes reabsorption of Na and secretion of K+ and H+, so if you have too much aldosterone, you'll secrete too much H+, lose too much acid, and have an alkalosis state.)
What is the primary *mineralocorticoid* synthesized in adrenal cortex?
aldosterone
Would you treat Addison's patients with a high or low dose of glucocorticoids?
high dose (Addison's happens when a patient LACKS glucocorticoids) (Addisons: A = Away)
Would you expect aldosterone to increase of decrease BP? Why?
increase (Na+ retention --> more salt raises BP)
What dietary restrictions would you probably give to someone on the mineralocorticoid, Fludrocortisone [Florinef] based on its effects on electrolyte levels?
restrict Na+ provide K+ supplementation (since mineralocorticoids retain Na+ and excrete K+)
