Questions and Case Studies – Adrenal Pharmacology

00:01 Okay, let's do some questions. Question number 1. An 88 year old woman was given oral prednisone for the treatment of her rheumatoid arthritis. What are the side effects of prednisone? Decrease in blood sugar? Decrease in weight? Decreased fat deposits in the shoulder and face? Decreased fat deposits in the subephithelial space of the hands? And decreased fluid retention? The answer is D, decreased fat deposits in the subepithelial space of the hands.

00:35 Remember that prednisone causes increased fat deposit in the face and shoulders, so people will have sort of that moon face, we often talk about that buffalo hump in the back, the quasimodo kind of look.

00:48 And also we have decreased fat in the back of the hands and it gives you that parchment like skin.

00:54 So patients will often have bruising on the back of the hands.

00:58 That's what we refer to as decreased fat deposits in the subepithelial spaces.

01:02 The other answers are all wrong. Prednisone will cause an increase in blood sugar.

01:08 Prednisone will cause an increase in weight. Prednisone will cause an increased fat deposits in the shoulder and face.

01:15 And prednisone will cause increased fluid retention.

01:20 Let's go on to the next question. An 8 year old boy presents with high blood pressure, precocious puberty, and an increased stature, meaning that he is tall.

01:31 He is diagnosed with Cushing's syndrome. Which of the following treatments is appropriate? A, prednisone. B, ketoconazole. C, fludrocortisone. D, ciprofloxacin. And E, dexamethason.

01:50 Good, the answer is ketoconazole. Remember that ketoconazole actually has some steroid reduction capability by blocking synthesis of androgenic steroids. Prednisone, fludrocortisone, and dexamethasone are all exogenous steroids and they are used in steroid replacement therapy or acute inflammation.

02:11 Ketoconazole is an antifungal, so sometimes on exams, the exam authors will put another antibiotic on there.

02:19 Ciprofloxacin is an antibiotic that has no steroid reduction capability.

02:24 Let's take a look at another question. A 29 year old male presents with a blood pressure of 190/44, a resting heart rate of 134, and tremor. His 24 hour urine for VMA is markedly positive.

02:40 He is diagnosed with pheochromocytoma. You are the anesthetist prepping him for surgery.

02:46 What blood pressure medication will you choose? Will it be pregalbumin, propathiouracil, phentolamine, propranolol, or pravastatin? Right, phentolamine is the correct answer. So, be careful with these kinds of questions, they are often thrown on your exam.

03:05 They will often have drugs that sound similar to the correct answer and sometimes it confuses you and intimidates you.

03:11 Go through it systematically, you'll get the question right.

03:14 Remember that we want a non-specific blocker to block the effects of the adrenaline and noradrenaline that is floating around.

03:23 Phentolamine is a non-specific blocker.

03:27 Propranolol is a beta 1 blocker. It's fairly specific, and the problem with propranolol is you can have unopposed alpha activity.

03:34 Pregalbumin is a pain medication, that's not correct. Propathiouracil is an anti-thyroid medication, and pravastatin is an anti-cholesterol medication.

03:44 And their only reason for being on this question is because they sound similar to the answer.

03:49 Well, there you have it. That's our entire section. I'm sure that you're going to do very well on the exams.

03:56 Thank you very much for watching and good luck.