Fichas
Corticosteroids (Glucocorticoids), Systemic
Fichas del conjunto (4)
- 1Give eg's of & indications for systemic corticosteroids.eg's: prednisolone, hydrocortisone, dexamethasone
Indications:
• Allergic or inflammatory disorders
• Autoimmune DS - eg IBD, inflammatory arthritis
• Rx of some CA's - as part of chemotherapy or to reduce tumour-associated swelling
• Hormone replacement in adrenal insufficiency or hypopituitarism - 2MOA of systemic corticosteroids.These corticosteroids exert mainly glucocorticoid effects. They bind to cytosolic glucocorticoid receptors, which then translocate to the nucleus & bind to glucocorticoid-response elements, which regulate gene expression. Corticosteroids are most commonly prescribed to modify the immune response. They upregulate anti-inflammatory genes & downregulate pro-inflammatory genes (e.g. cytokines, tumour necrosis factor alpha). Direct actions on inflammatory cells include suppression of circulating monocytes & eosinophils. Their metabolic effects include ^gluconeogenesis from ^circulating amino & fatty acids, released by catabolism (breakdown) of muscle & fat. These drugs also have mineralocorticoid effects, stimulating Na+ & water retention & K+ excretion in the renal tubule.
- 3SE's of systemic corticosteroids.• Immunosuppression - ^risk of infxn
• Metabolic effects - DM, osteoporosis. ^catabolism leads to muscle weakness, skin thinning, easy bruising, gastritis
• Mood & behavioural changes
• Mineralocorticoid actions - HT, hypokalaemia, oedema
• Adrenal atrophy - if corticosteroids are suddenly withdrawn after prolonged Rx this can lead to Addisonian crisis
• Sx of chronic glucocorticoid deficiency that occur during Rx withdrawal include fatigue, weight loss & arthralgia (severe P in a joint without swelling or signs of arthritis) - 4CI's, cautions, & important interactions of systemic corticosteroids.CI's:
• None
Cautions:
• People with infxn
• Children - can suppress growth
Important interactions:
Corticosteroids ^the risk of peptic ulceration & GI bleeding when used with NSAIDs & enhance hypokalaemia in pt's taking β2-agonists, theophylline, loop or thiazide diuretics. Their efficacy may be reduced by cytochrome P450 inducers (e.g. phenytoin, carbamazepine, rifampicin). Corticosteroids reduce the immune response to vaccines.