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Chapter 72
Glucocorticoids in Nonendocrine
Disorders
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
Glucocorticoid Drugs
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Also known as corticosteroids and nearly
identical to steroids produced by the adrenal
cortex
Physiologic effects (low doses)
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Modulation of glucose metabolism in
adrenocortical insufficiency
Pharmacologic effects (high doses)
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Suppression of inflammation
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Glucocorticoids in
Nonendocrine Disorders
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Glucocorticoid physiology
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Metabolic effects
Cardiovascular effects
Effects during stress
Effects on water and electrolytes
Respiratory system in neonates
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Pharmacology of Glucocorticoids
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Molecular mechanisms of action different
from those of other drugs
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Glucocorticoid receptors are inside the cell
Glucocorticoids modulate the production of
regulatory proteins vs. signaling pathways
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Pharmacology of Glucocorticoids
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Effects on metabolism and electrolytes
Anti-inflammatory and immunosuppressant
effects
Therapeutic uses in nonendocrine disorders
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Rheumatoid arthritis
Systemic lupus erythematosus
Inflammatory bowel disease
Miscellaneous inflammatory disorders
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Pharmacology of Glucocorticoids
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Therapeutic uses in nonendocrine disorders
(cont’d)
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Allergic conditions
Asthma
Dermatologic disorders
Neoplasms
Suppression of allograft rejection
Prevention of respiratory distress syndrome
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Fig. 72–1. Feedback regulation of glucocorticoid synthesis and secretion.
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Pharmacology of Glucocorticoids
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Adverse effects
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Adrenal insufficiency
Osteoporosis and resultant fractures
Infection
Glucose intolerance
Myopathy
Fluid and electrolyte disturbances
Growth retardation
Psychologic disturbances
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Pharmacology of Glucocorticoids
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Adverse effects (cont’d)
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Cataracts and glaucoma
Peptic ulcer disease
Iatrogenic Cushing’s syndrome
Use in pregnancy and lactation
Drug interactions
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Interactions related to potassium loss
Nonsteroidal anti-inflammatory drugs
Insulin and oral hypoglycemics
Vaccines
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Pharmacology of Glucocorticoids
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Contraindications
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Patients with systemic fungal infections
Those receiving live virus vaccines
Use with caution in pediatric patients and in
pregnancy/breast-feeding
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Pharmacology of Glucocorticoids
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Adrenal suppression
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Why it can develop
Adrenal suppression and physiologic stress
Glucocorticoid withdrawal
• Taper the dosage over 7 days
• Switch from multiple doses to single doses
• Taper the dosage to 50% of physiologic values
• Monitor for signs of insufficiency
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Glucocorticoid Routes
of Administration
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Oral, parenteral (IV, IM, subQ), and topical
Individual glucocorticoids differ in three ways:
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Biologic half-life
Mineralocorticoid potency
Glucocorticoid potency
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Glucocorticoid Dosage
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Highly individualized
Determined empirically (trial and error)
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No immediate threat—start low and slow
Immediate threat—start high; decrease as possible
Long-time use—smallest effective amount
Prolonged treatment with high doses only if disorder
is life-threatening or has potential to cause
permanent disability
Increased in times of stress
Gradual weaning
Alternate-day therapy
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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