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Thread: Corticosteroids

  1. #11
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    Cool heya!!

    SHORT SYNOPSIS OF CORTICOSTEROID ACTIONS
    Important to distinguish between physiological effects (replacement therapy) and pharmacological effects (occur at higher doses)
    Mineralocorticoid
    • Na retention by renal tubule
    • increased K excretion in urine

    Glucocorticoid
    • CHO metabolism: increased gluconeogenesis, ± peripheral glucose uptake may be decreased with resultant hyperglycaemia ± glycosuria
    • protein metabolism: anabolism is decreased but catabolism continues unabated or is increased resulting in negative N balance and muscle wasting. Osteoporosis occurs, growth slows in children, skin atrophies (together with increased capillary fragility leads to bruising and striae), healing and fibrosis delayed
    • fat deposition: increased on shoulders, face and abdomen

    • inflammatory response depressed

    • allergic response depressed

    • antibody production reduced by large doses

    • lymphoid tissue reduced (including leukaemic lymphocytes)
    • decreased eosinophils

    • renal urate excretion increased

    • euphoria or psychotic states may occur. ? due to CNS electrolyte changes
    • anti-vitamin D action
    • reduction of hypercalcaemia (chiefly where this is due to increased absorption from gut: vit D intoxication, sarcoidosis)
    • increased urinary Ca excretion. Renal stones may form
    • growth reduction where new cells are being added (eg in children) but not where they are replacing cells as in adult tissues
    • suppression of HPA axis. NB steroid suppressed adrenal continues to secrete aldosterone

    Normal daily secretion of hydrocortisone is 10-30 mg. Exogenous daily dose that completely suppresses cortex is 40-80 mg (or prednisolone 10-20 mg).
    O you who believe! Seek help in patience and As-Salāt (the prayer). Truly! Allāh is with As-Sābirin (the patient ones). (Al-Baqarah 2:153)

  2. #12
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    Gr8!! I like zt!!
    I'll put sme pic later, wen I revise zt.

  3. #13
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    Cool Individual steroids!!

    • prednisolone is standard choice for anti-inflammatory therapy. Can be given orally or IM
    • methylprednisolone used for IV pulsed therapy
    • dexamethasone longer acting.
    • fludrocortisone used to replace aldosterone where the adrenal cortex has been destroyed
    • beclomethasone and budesonide used by inhalation for asthma
    .
    About 90% of inhalation dose is swallowed and inactivated by first-pass hepatic metabolism (steroids listed above are protected from this by protein binding). The rest, which is absorbed from the mouth and lungs gives very low systemic plasma concentrations. Although risk of HPA axis suppression is very low it can happen.
    O you who believe! Seek help in patience and As-Salāt (the prayer). Truly! Allāh is with As-Sābirin (the patient ones). (Al-Baqarah 2:153)

  4. #14
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    Cool Pharmacokinetics!!

    Administration: PO/IM/IV/intra-articular/topical/inhaled. Absorption after oral administration is rapid. Maximum biological effect seen after 2-8 h
    Distribution: high plasma protein binding (95% in case of hydrocortisone) to transcortin and when this is saturated to albumin (80% in the case of hydrocortisone). Concentration of transcortin is increased by oestrogens (eg pregnancy, oral contraceptives). In patients with very low serum albumin doses should be reduced due to reduced binding capacity
    Elimination: hepatic and renal.t1/2 of most steroids 1-3 h. Prolonged in renal and hepatic disease and shortened by hepatic enzyme induction to an extent that may be clinically important
    O you who believe! Seek help in patience and As-Salāt (the prayer). Truly! Allāh is with As-Sābirin (the patient ones). (Al-Baqarah 2:153)

  5. #15
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    Cool ADR and Use in pregnancy!!

    Adverse effects
    In general serious unwanted effects are unlikely if daily dose is < 50 mg hydrocortisone or 10mg of prednisolone or equivalent
    • iatrogenic Cushing
    s
    • avascular necrosis of bone
    • depression and psychosis
    • peptic ulceration

    • others include cataract (chronic use), glaucoma (prolonged use of eye drops), raised ICP and convulsions, blood hypercoagulability, menstrual disorders, fever
    • immunosuppression
    • HPA axis suppression:
    :dependent on steroid used, dose, duration of administration and time of administration. Single morning dose of <20mg prednisolone does not usually cause suppression while 5mg in evening suppresses early morning activation of HPA axis
    Use in pregnancy
    • teratogenic in animals
    • ? relationship between high dose steroids and cleft palate and other fetal abnormalities
    • adrenal insufficiency due to HPA axis suppression in newborn only occurs with high maternal doses

    • keep doses as low as possible in pregnancy

    • avoid fluorinated steroids (eg dexamethasone) as they are more teratogenic in animals
    O you who believe! Seek help in patience and As-Salāt (the prayer). Truly! Allāh is with As-Sābirin (the patient ones). (Al-Baqarah 2:153)

  6. #16
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    Smile Howzzat!!

    Hey this thread is now complete... the whole pharmacology of corticosteroids is done with...Cheers!!
    O you who believe! Seek help in patience and As-Salāt (the prayer). Truly! Allāh is with As-Sābirin (the patient ones). (Al-Baqarah 2:153)

  7. #17
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    Hey thnxs loads!!!
    Zis gonna help me loads for exams!!
    u r my fav on this forum:-)
    keep posting.

  8. #18
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    Smile He He....

    Quote Originally Posted by Oodesh View Post
    Hey thnxs loads!!!
    Zis gonna help me loads for exams!!
    u r my fav on this forum:-)
    keep posting.
    zts sweetand very flattering i should say..but may be u think i hand-typed all that stuff..to be honest,i jus flicked it from some site and added bullets and colours..I ve posted the link to that site in "crispy notes" thread..check it out wen u've the time oodesh..if u found this good,am sure ull love the other drug notes there toohappy weekend
    O you who believe! Seek help in patience and As-Salāt (the prayer). Truly! Allāh is with As-Sābirin (the patient ones). (Al-Baqarah 2:153)

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