Adrenal Steroids Flashcards
Effects of glucocorticoids
Anti-inflammatory effects
- vasoconstriction, decrease vascular permeability
- inhibit formation of arachidonic acid
- complex effects on WBC
- alter cytokine formation
Hydrocortisone
Prototype for short duration w/ GC but also MC side effects
Half life 8-12 hours
Useful for mild inflammation, significant MC side effects prevent use of these drugs at high enough concentrations to treat severe inflammation
surfactant production
Prednisone
Intermediate duration half life = 24 hr
Higher potency (5x more than hydrocortisone)
Less MC side effects (5x more selective for GC than MC receptors)
most common for anti-inflamm
Can be used for CA tx regimen (cytotoxic)
Dexamethasone
Long duration drug (half-life 2 days)
High potency (20-30x more)
NO MC EFFECTS
other use: following brain surgery to minimize postoperative cerebral edema
Fludrocortisone
MC agonist Oral, long-lasting **Drug of choice for MC effects** Some GC effects (minimal) Replacement therapy in adrenal failure
MC receptor effects
Increased Na and decreased K
water retention, HTN, edema
Alkalosis
avoid w/ more selective GC anti-inflammatories
GC receptor side effects
Proportional to anti-inflammatory effects *Muscle wasting, weakness *Skin thinning, easy bruising *Fat redistribution, truncal obesity *Osteoporosis Peptic ulcer DM or insulin resistance Inhibition of growth in children CNS disturbances Cataracts/glaucoma *Poor wound healing (decreased fibrin and collagen) *Increased risk of infx *Decreased ability to respond to stress
Strategies to prevent toxicity
- last resort
- smallest effective dose possible
- reduce symptoms not eliminate
- localized administration (not systemic)
- careful when switching systemic to local
- alternate day administration
Spironolactone
MC receptor antagonist (blocks)
K+ sparing diuretic
blocks aldosterone
decreases MC effects in endocrine disorders
