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24 Cards in this Set
- Front
- Back
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Two therapeutic uses for Glucocorticoids
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-Hormone Replacement Therapy
-Non-endocrine disordors |
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-Must be converted to cortisol
-Mainly acts as a mineralocorticoid |
Cortisol
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-Must be converted to Pednisolone in liver
-Best for anti-inflammatory effects d/t lack of mineralocorticoid activity |
Prednisone
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Enzyme that converts Prednisone to Prednisolone in the liver
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11-beta-Hydroxysteroid dehydrogenase
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More toxic glucocorticoid
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Triamcinolone
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250x more potent -mineralocorticoid than cortisol
-Only orally available mineralocorticoid -Not used as a GC d/t salt retention and CV effects |
Fludrocortisone Acetate
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Physiologic effects of non-endocrine use of glucocorticoids
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-Muscle wasting, weakness
-Osteoporosis -thinning skin -Inhibition of growth in children -CNS effects |
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CNS Effects of GC use in patients with Addisons
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Apathy, depression, irritability, frank psychosis
(who's Frank =)) |
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CNS Effects of GC use in Non-addisons patients
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Euphoria, insomnia, restlessness, increased motor activity, eeg changes
(anxiety, depression, phsychosis sometimes) |
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Effects of GC on the bone
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-Decreased bone mass due to suppression of catabolic activity of osteoblasts (bone builders)
-Inhibition of Ca++ absorption by the gut and REabsorption by the kidneys -OSTEOPOROSIS |
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GC and the Immune system
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-Requires high doses of GC
-suppresses all aspects of immune response(humoral and innate) -Alters concentration, distribution, function of immune cells -Inhibits Cytokines |
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Cytokines inhibited by GC
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IL-1, 2, 3, 6, 8, 12, IFN-Gamma, GM-CSF, NOS-2, COX-2
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Indications for glucocorticoids
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-TONS
-Addisons, adrenal hyperplasia, asthma, crohn's, dermatitis, organ transplants (to suppress rejection), rheumatoid arthritis, thyroididtis |
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Alternate Day dosing of GC in chronic therapy
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-Mimics Circadian rhythm of GC
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Dietary Changes for patients on long term GC therapy
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-High protein/potassium
-Low sodium -Calorie reduction, overall |
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Termination of GC therapy
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-Must be gradual d/t suppression of Hypothalamus-Pituitary-Adrenal axis
-Patient cannot adequatly respond to stress -CAN CAUSE FLARE UP OF UNDERLYING DISEASE FOR WHICH GH WAS PRESCRIBED |
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Flonase
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Intranasal GC used for rhinitis
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Topical GC
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-Used for dermatitis
-Can cause systemic suppresion of HPA axis |
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Medrysone
Fluorometholone |
-Topical GC
-Treat Eye Inflammation -Cause Increased IO Pressure->glaucoma (systemic GC do NOT cause glaucoma) |
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GC withdrawal Syndrome
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Fever, myalagias (muscle pain), arthralagias (joint pain), malaise.
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Cushings Syndrome
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-Adverse effect of GC treatment
-100mg for >2wks can cause it |
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Metabolic disorders associated with GC use
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-Pseudo-NIDDM(non-insulin dep.)->Hyperglycemia, glucosuria
-Negative Nitrogen balance -increased protein catabalism (breakdown)->decreased wound healing, altered fat distribution |
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Adverse effects of GC on electrolytes and Vitamins
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-Hypokalemia alkalosis
--edema --muscular weakness --abn EKG -Decreased Ca++ abs in gut -Calciuria->dec repabsorption of Ca++ in tubules -Inhibition of carotene conversion to vitamin A |
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Contraindications of prednisolone use
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Absolutely no--
Varicella, Chicken Pox, Cushings, Fungal Infection, Measles -Discontinue IMMEDIATLEY |
