Transcript Glucocorticoids

Corticosteroids
Corticosteroids
• Corticosteroids suppress immune responses
and reduce inflammation.
• available as natural or synthetic steroids.
• Natural corticosteroids are hormones
produced by the adrenal cortex;
• Natural and synthetic corticosteroids are
classified according to their biological
activities:
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• • Glucocorticoids, such as cortisone acetate
and dexamethasone,affect carbohydrate and
protein metabolism.
• • Mineralocorticoids, such as aldosterone and
fludrocortisone acetate,regulate electrolyte
and water balance.
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Glucocorticoids
• Most glucocorticoids are synthetic analogues of
hormones secreted by the adrenal cortex:
• • beclomethasone
• • betamethasone
• • cortisone
• • dexamethasone
• • hydrocortisone
• • methylprednisolone
• • prednisolone
• • prednisone
• • triamcinolone.
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Pharmacokinetics
• Glucocorticoids are well absorbed when
administered orally.
• After I.M. administration, they’re absorbed
completely.
• Glucocorticoids are metabolized in the liver
and excreted by the kidneys.
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Pharmacodynamics
• Glucocorticoids suppress
hypersensitivity and immune
responses through a process that
isn’t entirely understood.
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Researchers believe that glucocorticoids inhibit immune responses by:
• suppressing or preventing cell-mediated immune reactions
• reducing levels of leukocytes, monocytes, and eosinophils
• decreasing the binding of immunoglobulins to cell surface receptors
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…Pharmacodynamics
- Glucocorticoids suppress the redness, edema,
heat, and tenderness associated with the
inflammatory response.
- prevent the leakage of plasma from capillaries,
suppress the migration of polymorphonuclear
leukocytes (cells that kill and digest
microorganisms), and inhibit phagocytosis
(ingestion and destruction).
- decrease antibody formation in injured or infected
tissues .
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Pharmacotherapeutics
• replacement therapy for patients
with adrenocortical insufficiency,
• glucocorticoids are prescribed for
immunosuppression and reduction
of inflammation.
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Adverse reactions to corticosteroids
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• insomnia
• increased sodium and water retention
• increased potassium excretion
• suppressed immune and inflammatory responses
• osteoporosis
• intestinal perforation
• peptic ulcers
• impaired wound healing.
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• Endocrine system reactions may include:
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• diabetes mellitus
• hyperlipidemia
• adrenal atrophy
• hypothalamic-pituitary axis suppression
• cushingoid signs and symptoms (such as buffalo
hump,moon face, and elevated blood glucose
levels).
nursing
- Administer drug daily at 8 to 9 am to mimic normal peak
diurnal concentration levels and thereby minimize
suppression of the hypothalamic–pituitary axis.
- Use the minimal dose for the minimal amount of time to
minimize adverse effects.
- Taper doses when discontinuing from high doses or
from long-term therapy .
- Do not give live virus vaccines when the patient is
immunosuppressed because there is an increased risk
of infection.
- Protect the patient from exposure to infection .
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Mineralocorticoids
• Mineralocorticoids affect electrolyte and
water balance. These drugs include:
• • fludrocortisone acetate, a synthetic
analogue of hormones secreted by the
adrenal cortex
• • aldosterone, a natural mineralocorticoid
(the use of which has been curtailed by high
cost and limited availability).
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Pharmacokinetics
• Fludrocortisone acetate is metabolized in the
liver to inactive metabolites.
• .The drug is excreted by the kidneys.
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Pharmacodynamics
• Fludrocortisone acetate affects fluid and
electrolyte balance by acting on the distal
renal tubule to increase sodium reabsorption
and potassium and hydrogen secretion.
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Pharmacotherapeutics
• Fludrocortisone acetate is used as
replacement therapy for patients with
adrenocortical insufficiency .
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Implementation With Rationale
- Monitor for hypokalemia.
- Discontinue if signs of overdose (excessive
weight gain, edema, hypertension,
cardiomegaly) occur to prevent the
development of more severe toxicity.
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