Glucocorticoids! Flashcards
Name the SAIDs
- Cortisol (short)
- Prednisolone (medium)
- Methylprednisolone (medium)
- Triamcinolone (medium)
- Betamethasone (long)
- Dexamethasone (long)
- Beclamethason (local) CAT
- Fluticason (local) HORSE
- Budesonide (Oral)
Physiological and pathological effects, catabolism of Glucocorticoids:
- Diabetogenic (decrease glucose uptake, but increase gluconeogenesis)
- Stress hormone
hyperglycaemia
- Muscle atrophy, weakness osteoporosis (decrease calsium absorption)
- Skin thinning , alopecia
- Decreased growth
- They decrease collagen synthesis, leading to delayed wound healing.
- Polyuria/polydipsia (ADH inhibition, not allowing kidneys to resorb water)
Pharmacological effects of glucocorticoids
- Antiinflammatory (depress cox expression, cox produces prostaglandins which promote inflammation,pain and fever)
- Antiallergic
- Immunosupressive
- antishock (The capillary membrane permeability decreases with will enhance microcirculation. )
- Neuroprotective
Side effects of glucocorticoids
The side effects of glucocorticoids are many, long-term and dangerous.
1.HT-hypophysis-adrenal cortex axis inhibition
- Glucocorticoids suppress ATCH synthesis.
- After 1-2 week adrenal cortex atrophy will happen. There will be a slow, continuous ending, several days.
2.Gastric ulcers:
- Inhibition of prostaglandins – Omeprazol
- Need gastroprotectives.
3.Hepatopathy
- ALKP significant increase
- Need hepatoprotectives, like silimarine
4.Pancreatitis
-Abdominal pain, fever, vomiting, not frequent
5.Glaucome, cataracta
- Irreversible change
- Long term
6.Thinning of skin, delayed wound healing, alopecia
- decreased growth, not in younger than 1 year cat and dogs, 1,5 year old horse, not in children.
- The delayed wound healing can be a problem during surgeries.
7.Polyuria/polydipsia
8.Polyphagia
-Increased appetite, so it can be used as a drug for increasing appetite.
9.Remobilizing fats
-Belly in animals, face of humans
10.Muscle atrophy
11.Immunosupression
- Viral infections – respiratory tracts
- Predisposed to cancer.
Systemic usage of glucocorticoids:
1.High dosage, once
-Short term, few side effects (shock, spinal trauma, allergy, anaphylaxis, gastric ulceration is pronounced, must be given with omeprazole.
2.ADT (alternate day therapy)
- Long term, unfortunate.
- Predisolone, methylprednisolone.
- Morgnings of dogs, evenings for cats, when the endogenous peaks are occurring.
3.Long acting injections (depot)
- not recommended!!
- Supress adrenal cortex + atrophy
- Only if ADT is not possible, the tablet cannot be administered.
- Safer when given interarticular.
Indications recommended order of glucocorticoids:
- Local use (atopic dermatitis, otitis externa, mastitis)
- Careful topical treatment – absorption can lead to adrenocortex suppression. - Single injectable dose
- Asthma, RAO – Inhalation usage (Fluticasone)
- Intraarticular – (Triamcinolone)
- ADT - allergy, immunosuppression.
- Depot injections
- Only if ADT is not possible
