Drug Therapy With Corticosteroids PDF

Chapter 17 Drug Therapy With Corticosteroids  Hormones produced by the adrenal cortex, Corticosteroids affect almost all body organs Extremely important in maintaining homeostasis when secreted in normal amounts...

Chapter 17 Drug Therapy With Corticosteroids  Hormones produced by the adrenal cortex, Corticosteroids affect almost all body organs Extremely important in maintaining homeostasis when secreted in normal amounts Disease results from inadequate or excessive secretion. Corticosteroids used as medications are referred to as exogenous corticosteroids. 2 Copyright © 2025 Wolters Kluwer. All rights reserved.  Secretion into bloodstream controlled by Endogenous oHypothalamus Corticosteroids oAnterior pituitary #1 oAdrenal cortex Various stimuli activate the system oAmount of secretion varies according to need. oGoverned by a negative feedback system Does not function during stress responses 3 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #1 Corticosteroid secretion is extremely important in maintaining homeostasis. 4 Copyright © 2025 Wolters Kluwer. All rights reserved.  True Answer to Question #1 Rationale: Corticosteroid secretion is extremely important in maintaining homeostasis when secretion is within normal amounts. 5 Copyright © 2025 Wolters Kluwer. All rights reserved.  Types Endogenous oGlucocorticoids Corticosteroids oMineralocorticoids #2 oAdrenal sex hormones All derived from cholesterol Have similar chemical structures Slight differences facilitate different functions. 6 Copyright © 2025 Wolters Kluwer. All rights reserved.  Glucocorticoids Endogenous oImportant in metabolic, inflammatory, and Corticosteroids immune processes #3 oInclude cortisol, corticosterone, and cortisone oSecreted cyclically (largest amount upon awakening; smallest amount before sleep) oAccount for most of the characteristics and physiologic effects of corticosteroids 7 Copyright © 2025 Wolters Kluwer. All rights reserved.  Mineralocorticoids Endogenous oVital role on maintenance of fluid–electrolyte Corticosteroids balance #4 Influences salt and water metabolism oAldosterone the main mineralocorticoid 8 Copyright © 2025 Wolters Kluwer. All rights reserved.  Adrenal sex hormones Endogenous oSecreted continuously in small amounts by Corticosteroids both genders #5 oAndrogens (male) Increase protein synthesis, which increases mass and strength of muscle and bone tissue Affect development of secondary male characteristics 9 Copyright © 2025 Wolters Kluwer. All rights reserved.  Adrenal sex hormones (cont.) Endogenous oAndrogens (male) (cont.) Corticosteroids Increase hair growth and libido in women #6 Excessive secretions in women cause masculinizing effect Estrogens and progesterone (female) oNormally exert few physiologic effects oExcessive secretions in men may cause feminizing effect. 10 Copyright © 2025 Wolters Kluwer. All rights reserved.  Mechanisms of action General oBind to glucocorticoid receptors in target Characteristics of tissues at the cellular level Exogenous oIncrease or decrease transcription of many Corticosteroids genes to alter protein synthesis regulating physiologic effects oVariety in genes produces varying effects 11 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #2 Exogenous corticosteroids exert the same effects on all tissues treated. 12 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #2 Rationale: Exogenous corticosteroids exert varying effects depending on the genetics of the tissue being treated. 13 Copyright © 2025 Wolters Kluwer. All rights reserved.  Extensively used Indications for Treat disorders of the adrenal cortex or Use of Exogenous endocrine system Corticosteroids Uses largely based on experienced effects #1 Indicatory disorders include oAllergic/hypersensitivity disorders oCollagen disorders oDermatologic disorders 14 Copyright © 2025 Wolters Kluwer. All rights reserved.  Indicatory disorders include (cont.) Indications for oEndocrine and gastrointestinal disorders Use of Exogenous oHematologic and hepatic disorders Corticosteroids oNeoplastic and neurologic conditions #2 oOphthalmic disorders oOrgan/tissue transplants and grafts oKidney disorders 15 Copyright © 2025 Wolters Kluwer. All rights reserved.  Indicatory disorders include (cont.) Indications for oRespiratory disorders Use of Exogenous oRheumatic disorders Corticosteroids oShock #3 16 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #3 Exogenous corticosteroids are quite effective in the treatment of systemic fungal infections. 17 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #3 Rationale: Exogenous corticosteroids are contraindicated in the treatment of systemic fungal infections. 18 Copyright © 2025 Wolters Kluwer. All rights reserved.  Systemic fungal infections Contraindications Used with caution in patients for Use of oAt risk for infections (may decrease Exogenous resistance) Corticosteroids oWith infections (may mask S/S) oWith DM (may cause/increase hyperglycemia) oWith peptic ulcer disease 19 Copyright © 2025 Wolters Kluwer. All rights reserved.  Used with caution in patients (cont.) Contraindications oWith inflammatory bowel disorders for Use of oWith hypertension Exogenous oWith heart failure Corticosteroids oWith abnormal kidney function (cont.) 20 Copyright © 2025 Wolters Kluwer. All rights reserved.  Given mainly for replacement or therapeutic Dosing of purposes Exogenous oReplacement: small doses to correct a Corticosteroids deficiency state and store normal function Physiologic effects oTherapeutic: relatively large doses to exert new effects not experienced with physiologic dose Pharmacologic effects 21 Copyright © 2025 Wolters Kluwer. All rights reserved.  Glucocorticoid desired effects Pharmacologic oAnti-inflammatory Effects of oImmunosuppressive Exogenous oAntiallergic Corticosteroids oAntistress 22 Copyright © 2025 Wolters Kluwer. All rights reserved.  Goal of therapy Principles of oReduce symptoms to a tolerable level Corticosteroid Palliative, not curative Therapy #1 oAvoid serious adverse reactions Drug selection factors oPurpose of use oSpecific medication characteristics 23 Copyright © 2025 Wolters Kluwer. All rights reserved.  Drug selection factors (cont.) Principles of oDesired route of administration Corticosteroid oIndividual characteristics of the patient Therapy #2 oExpected adverse effects Drug dosage factors oSpecific medication characteristics oReason for use 24 Copyright © 2025 Wolters Kluwer. All rights reserved.  Drug dosage factors (cont.) Principles of oDesired route of administration Corticosteroid oExpected adverse effects Therapy #3 oCharacteristics of the patient 25 Copyright © 2025 Wolters Kluwer. All rights reserved.  Drug dosage guidelines Principles of oSmallest effective dose for shortest effective Corticosteroid time Therapy #4 oDosages must be individualized by Severity of disorder Acute or chronic condition The patient’s response to drug therapy 26 Copyright © 2025 Wolters Kluwer. All rights reserved.  Drug administration Principles of oRoutes Corticosteroid Desired effects—local or systemic Therapy #5 Local administration prevents/decreases systemic toxicity Oral route (preferred) Parenteral (IM, IV) 27 Copyright © 2025 Wolters Kluwer. All rights reserved.  Frequency of administration Principles of oScheduling more important than with most Corticosteroid other medications Therapy #6 oMost adverse effects occur Long-term administration of high doses oMajor adverse reaction Loss of adrenocortical function 28 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #4 Local/topical administration of corticosteroids is preferable (when applicable) to decrease opportunity of systemic toxicity. 29 Copyright © 2025 Wolters Kluwer. All rights reserved.  True Answer to Question #4 Rationale: Local administration of corticosteroids prevents or decreases possibility of systemic toxicity. 30 Copyright © 2025 Wolters Kluwer. All rights reserved.  Frequency of administration (cont.) Principles of oAcute situations Corticosteroid Large, divided doses for ~48 to 72 hours Therapy #7 Remaining dosage tapered Allergic reactions; contact dermatitis Chronic condition exacerbation Surgery 31 Copyright © 2025 Wolters Kluwer. All rights reserved.  Frequency of administration (cont.) Principles of oAlternate-day therapy Corticosteroid Double dose taken every other day Therapy #8 Allows rest period from medication Decreased adverse effects Anti-inflammatory effects continue Used for maintenance therapy 32 Copyright © 2025 Wolters Kluwer. All rights reserved.  Frequency of administration (cont.) Principles of oAlternate-day therapy (cont.) Corticosteroid Double dose taken every other day effective Therapy #9 with Bronchial asthma Ulcerative colitis Started after symptoms subside and stabilize 33 Copyright © 2025 Wolters Kluwer. All rights reserved.  Frequency of administration (cont.) Principles of oAlternate-day therapy (cont.) Corticosteroid Intermediate-acting glucocorticoids are Therapy #10 drugs of choice. Other advantages Decreases infection susceptibility Does not retard growth in children 34 Copyright © 2025 Wolters Kluwer. All rights reserved.  Allergic rhinitis, arthritis, asthma Treatment of Cancer, primary CNS lymphomas, CNS tumors Specific Disorders Chemotherapy-induced emesis COPD, inflammatory bowel disease Spinal cord injury Prevention of acute adrenocortical insufficiency 35 Copyright © 2025 Wolters Kluwer. All rights reserved.  Children, older adults Use in Special Abnormal kidney function or hepatic Populations impairment Critical illness Adrenal insufficiency Acute respiratory failure in COPD, ARDS Sepsis, AIDS Home care 36 Copyright © 2025 Wolters Kluwer. All rights reserved.