Review of Pharmacology - 9E (2015)

Endocrinology
Drugs causing Addison’s disease are:
• Metyrapone
• Ketoconazole
• Aminoglutethimide
• Mitotane
108. Ans. (a) Chemotherapy induced vomiting (Ref: KDT 6/e p647)
109. Ans. (c) Collecting ducts (Ref: Katzung 10/e p240)
• Aldosterone is the principal mineralocorticoid. It stimulates the reabsorption of Na + and excretion of K + and H + by its
action on late distal tubules and collecting ducts.
110. Ans. (b) Acidosis (Ref: KDT 6/e p277)
111. Ans. (c) Phospholipase A (Ref: KDT 6/e p279)
112. Ans. (d) Lipocortin (Ref: KDT 6/e p279)
Corticosteroids induce the synthesis of lipocortins that inhibit the enzyme phospholipase A2.
113. Ans. (d) Methylprednisolone (Ref: KDT 6/e p281)
114. Ans. (a) Prednisolone 20 mg/day oral for one year (Ref: KDT 6/e p286)
• If used for more than two weeks, corticosteroids can lead to HPA-axis suppession. If discontinued abruptly, precipitation
of acute adrenal insufficiency can result. This is the most serious adverse effect seen with the use of corticosteroids
that can cause death of the patient.
115. Ans. (a) Congenital adrenal hyperplasia (Ref: KDT 6/e p283)
• Corticosteroids are used for the management of congenital adrenal hyperplasia.
• Corticosteroids can result in hyperglycemia and thus may vitigate the control of blood glucose in diabetics.
• Due to retention of Na + and water, corticosteroids can worsen the hypertension.
• By inhibiting the production of gastroprotective prostaglandins, corticosteroids increase the risk of peptic ulcer
disease.
116. Ans . (d) Suppression of ACTH secretion (Ref: KDT 6/e p283)
In congenital adrenal hyperplasia, due to decreased formation of steroids, there is decreased feedback inhibition of ACTH.
Thus more ACTH is formed which leads to adrenal hyperplasia. Thus exogenous steroids are given to suppress ACTH
secretion.
117. Ans (b) Osteoporosis (Ref: KDT 6/e p286)
Glucocorticoids have lot of adverse effects on long term use. These can lead to Cushing syndrome, hyperglycemia, osteoporosis,
delayed wound healing, increased susceptibility to infections, cataract, glaucoma and many other adverse effects.
118. Ans. (c) No change/increase in prednisolone dose (Ref: KDT 6/e p283)
• During conditions of stress or infection, dose of steroids should not be decreased. Rather, increase in dose may be
required.
119. Ans. (a) They do not cause Na + and water retention (Ref: KDT 6/e p285)
• Triamcinolone, betamethasone, dexamethasone and paramethasone are selective glucocorticoids (have zero mineralocorticoid
action).
• These are preferred for cerebral edema because they lack salt and water retaining potential (mineralocorticoid action).
120. Ans. (c) Cortisol and fludrocortisone (Ref: KDT 6/e p282)
Patient should be given both mineralocorticoids as will as glucocorticoid.
Max. mineralocorticoid activity – Aldosterone
Max. glucocorticoid activity – Dexamethasone
121. Ans. (c) Betamethasone (Ref: KDT 6/e p282, 287)
Steroids with long half life like betamethasone and dexamethasone cannot be used for alternate day therapy because even
in alternate day therapy there will be sufficient blood levels of these steroids to cause suppression of HPA axis.
General Endocrinology Pharmacology
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