Adrenocorticosteroids

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corticosteroids

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group of agents secreted by adrenal cortex that mimic the endogenous steriod hormones produced. Regulated by ACTH

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Adrenocorticol hormones are steriods derived from

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cholesterol

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Healthy person~ ____ cortisol/day
Stress~_____

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20 mg
250-320 mg
peak level 4-8 am

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95% of glucocorticoid activity of adrenocortical secretions results from the secretion of cortisol known as __________

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hyrdocortisone

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Cortisol binds with ______

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globulin and albumin (94% is bound 6% is free)

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cortisol is metabolized in the _________ and excreted in the__________

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liver
urine (75%) and bile (25%)

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How does cortisol help with inflammation?

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Stabilizes lysosomal membranes and lowers fever. Lowers the permeability of capillaries, the migration of WBCs into the inflammed area & phagocytosis of damaged cells. It suppresses the immune system and lowers lymphocytes.

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Metabolic effects of cortisol

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lowers eosinophils & lymphocytes & atrophy of lymphoid tissues. Thins the epithelium, stimulates lypolysis.

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Pregnancy risk of cortisol

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DOES cross the placental barrier. birth defect in animal, no evidence in human.. might decrease birthweight and increase still birth.

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What CS should you take when pregnant?

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prednisone

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Should pedo pts take CS drugs?

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use extreme caution because of retardation of growth

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Indications for CS use

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Oral inflammatory conditions
Autoimmune diseases
Asthma
Dermatology
Immunosuppression
Oncology

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most common complications of CS use?

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negative Ca balance --> osteoporosis
increase apetite, obesity, impaired wound healing, increased risk for infection, suppression of hypothalmic-pituitary-adrenal axis, and growth arrest in children.

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cushings syndrome

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hormonal disorder caused by prolonged exposure of the body's tissues to high levels of cortisol. sometimes called hypercorisolism, and is rare and only affects age 20-50

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Addison disease

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primary adrenocortical insufficiency, etiology: auto-immune process, infectious disease, malignancy. After 90% of the glandular tissue destruction te clinical symptoms start.

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clinical symptoms of addison disease

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weakness, fatigue, anorexia, nausea, diarrhea, flu-like symptoms, weight loss, craving for salt, inability to tolerate stress, hypotension, hyperpigmentation

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dental implications

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vesiculobullous autoimmune disorders- ELP, Pemphigus, Pemphigoid

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different forms of CS

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systemic, spray, rinse, topical

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systemic dose of CS

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1mg/kg body weight, so for 70 kg man, usual dose is 60-80, if pt is on more than 2 weeks, dose should decrease then stop, if therapy is intended for weeks or months, use alternative day therapy

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medrol dose pack

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6 days dose from 60-100 mg over 6 days (SHORT DURATION TX)

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CS Tx complications

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adrenal gland function suppressed for 2 weeks! may not return to normal for 9-12 months!

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adrenal crisis

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low level of corticosteroid due to suppressed adrenal gland. headache, fainting, dizziness, lethargy, hypotension, hypoglycemia, dehydration

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Tx of Adrenal crisis

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PO prednisone 60 mg or IV hydrocortisone 100 mg

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Potency of Glucocortisone

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determined on the basis of the vasoconstrictor assay. *The biotransformation of the glucocorticoid molecule inside the dermis greatly influences potency of topical GC

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short acting GCS

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Glucocortisone, cortisone

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intermediated acting GCS

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methylprednisolone, prednisolone, prednisone, triamcinolone

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long acting GCS

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bethamethasone, dexamethasone

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ultra high potency topical corticosterioids

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clobetasol, bethamethasone

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high potency and potent topical CS

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fluocinonide, triamicinolone

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medium potent and mild topical CS

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tramicinalone, flucinolone

hydrocortisone

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cream vehicle

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low-fat formulation with higher H2O content and is more suitable for some skin conditions (eczema)

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fatty ointment vehicle

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MOST effective due to their occlusive capacity. it may increase the penetration of the active substance into deeper layer

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Topical in mixed in orabase paste eg:

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1% trimicinolone in 1% orabase for occulsion or use ointment of gel.

Ointment should be dabbed NOT rubbed. apply after meal and do not eat 30-60 min after application

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Oral rinse -dexamethasone

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0.5mg/5ml rinse one teaspoonful 1-2 min and spit DO NOT Swallow, moon face and weight gain seen in some pts.

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oral rinse- triamicinolone acetonide

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1-2% in aqueous suspension, rinse 5 ml 3-4 time/day

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topical steroid complications

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oral candidiasis, may spread herpes, high potency may cause adrenal suppression

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protocol for steroid supplement

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pts who are on daily steroid tx: 5-60 mg

mild-moderate stress: double does 60 mg on day of procedure and taper back to original in 2 days
highly stress- 60 mg on day and taper down in by 50% daily the next day and back to maintenance dose is reached

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protocol for steroid supplement in pts with a Hx of steroid use

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20 mg of prednisone, may have some adrenal suppression