Corticosteroids Drug Therapy PDF

- Chapter 17\ \ Drug Therapy With Corticosteroids - Corticosteroids - Hormones produced by the adrenal cortex, affect almost all body organs - Extremely important in maintaining homeostasis when secreted in normal amounts; disease results from inadequate or...

- Chapter 17\ \ Drug Therapy With Corticosteroids - Corticosteroids - Hormones produced by the adrenal cortex, affect almost all body organs - Extremely important in maintaining homeostasis when secreted in normal amounts; disease results from inadequate or excessive secretion. - Exogenous Corticosteroids - Prednisone -- prototype - Other drugs -- beclomethasone, betamethasone, budesonide, cortisone, dexamethasone, flunisolide fluticasone, hydrocortisone, methylprednisolone, prednisolone, triamcinolone - Action -- bind drug receptors on target cells, increasing or decreasing protein synthesis - Resulting in decreased inflammatory response (decreased edema by reducing chemicals that cause vasodilation and tissue irritation, causes immunosuppression, inhibit phagocytosis, impairs lymphocytes, inhibits tissue repair) - Uses -- to control symptoms (do not cure disease processes) - Allergic or hypersensitivity disorders - Collagen disorders (SLE) - Dermatologic disorders (dermatitis) - Endocrine disorders (adrenocortical insufficiency) - GI disorders (ulcerative colitis & Crohn's) - Hematologic disorders (idiopathic thrombocytopenic purpura) - Hepatic disorders with edema - Neoplastic disease (leukemia, Hodgkin's lymphoma) - Inhibit cell reproduction, cytotoxic to lymphocytes; also used to control symptoms of nausea & vomiting, cerebral edema, and inflammation from metastasis. - Neurologic conditions (cerebral edema, spinal cord injury) - Ophthalmic disorders (optic neuritis) - Organ or tissue transplants - Renal disorders with edema - Respiratory disorders (asthma, COPD, rhinitis) - Allergic rhinitis -- nasal spray to decrease mucus secretion and inflammation. Systemic effects are minimal - Asthma -- increase the effects of adrenergic bronchodilators, given orally or intravenous for 5-10 days, must be tapered after acute symptoms subside; inhaled corticosteroids is started during the taper. Black Box Warning for transferring from systemic to inhaled flunisolide have caused adrenal insufficiency and death - Rheumatic disorders (ankylosing spondylitis, bursitis, arthritis - Relieve pain, edema and mobility restrictions from joint inflammation. Given short term basis oral or joint injection - Shock from adddisonian crisis - Adverse Effects -- adrenocortical insufficiency, Cushingoid features (moon face), vertigo, insomnia, CV effects, decreased immunity (see page 347) - Contraindications - used cautiously in renal & hepatic impairment, elderly, patients with fungal infections, no live virus vaccinations if on steroids. - Licorice potentiates the effects of corticosteroids - Administration should be localized whenever possible. - Can be delivered in divided doses, - daily, every other day (alternate-day therapy), - stress dosing (chronic corticosteroid users get an increased dosage during stress/illness)