Glucocorticoid Receptor Antagonists

What is the primary goal of drug therapy in Cushing disease?

Decrease cortisol levels

Glucocorticoid receptor antagonists are used when:

Surgery is delayed or contraindicated

Cabergoline is classified as a:

Dopamine receptor agonist

Cabergoline works by:

Decreasing ACTH secretion

What is a contraindication for cabergoline?

Cardiac valvular disease

The most common side effect of cabergoline is:

Orthostatic hypotension

Pasireotide is classified as a:

Somatostatin analog

The mechanism of action of pasireotide is:

Inhibition of ACTH secretion

How long does it typically take to see full effect of pasireotide?

Approximately 2 months

Which laboratory values should be monitored for patients on pasireotide?

ALT and AST

Which adverse effect is associated with pasireotide?

Hyperglycemia

Ketoconazole inhibits:

The conversion of deoxycortisol to cortisol

Which class of drugs does ketoconazole belong to?

Antifungal

What is the FDA Black Box Warning for ketoconazole?

Hepatotoxicity

Patients should avoid combining ketoconazole with:

Echinacea

A major cardiovascular risk with ketoconazole is:

QT prolongation and Torsades de pointes

Ketoconazole absorption is enhanced by:

Acidic beverages (coffee, tea, juice)

Common side effects of ketoconazole include:

Gynecomastia and decreased libido

Mitotane is classified as a:

Antineoplastic

Mitotane is most useful in treating:

Adrenocortical carcinoma

The main therapeutic action of mitotane is:

Destruction of adrenal cortex

Metyrapone works by:

Inhibiting cortisol synthesis

Etomidate is used in which setting for Cushing disease?

ICU/emergency for severe hypercortisolism

A key nursing assessment for a patient on ketoconazole is:

Liver function tests

What is the proper administration instruction for ketoconazole?

Take with water or acidic drink to improve absorption

What is the primary use of mitotane (Lysodren)?

Treatment of inoperable adrenocortical carcinoma

How does mitotane work?

It causes adrenal cortical atrophy and decreases cortisol production

What is the typical onset of action of mitotane?

2–4 weeks

What is a key teaching point about the goal of mitotane therapy?

It shrinks tumor mass but does not cure the disease

A patient on mitotane develops trauma or shock. What must the nurse do?

Withhold mitotane and administer steroids

Mitotane is contraindicated in:

Patients with hypersensitivity to the drug

Common CNS side effects of mitotane include:

Depression, lethargy, dizziness

A patient on mitotane reports nausea, anorexia, and vomiting. What should the nurse monitor carefully?

Fluid and electrolyte balance

Mitotane metabolism occurs in the:

Liver

What must patients on mitotane be taught to report immediately?

Signs of adrenal insufficiency (weakness, hypotension, N/V, weight loss)