Rational Use of Glucocorticoids Flashcards
Give some examples of clinical uses of Glucocorticoids
Allergies, Immune mediated disease, replacement therapy, neoplasia, profound inflammation - controversial in shock
NEVER use glucocorticoids as… (4)
Appetite stimulant, Non-specific treatment, Suppression of pyrexia or inflam without knowing the cause, or before investigations concluded
What is important to remember about the anti-inflammatory and metabolic effects of glucocorticoids?
They are NOT separate. More anti-inflam, more metabolic effects.
How do the potency and effects of different glucocorticoids differ?
Some glucocorticoids affect mineralocorticoids and glucocorticoids but in different ratios. Also have different anti-inflam potencies.
How do glucocorticoids cause anti-inflammatory? Is this more or less anti-inflam than NSAID’s?
Inhibit phospholipase from forming arachadonic acid. More anti-inflam than NSAID’s because of immunomodification.
When treating immune mediated disease in cats/dogs, what is the dose rate of prednisone/prednisolone is required for inducing remission?
2-3mg/kg/24 hours in dog.
4-5mg/kg/24 hours in cat.
What are the key steps in treating immune disease in the cat and dog?
Induction of remission and then maintenance of remission.
What are the key steps in inducing remission of immune mediated disease with glucocorticoids?
High dose (2-3mg/kg dog, 4-5mg/kg cat), once daily for 10 days, then reduce to 2mg/kg dog, 3-4mg/kg cat once daily for days 10-20.
What are the key steps in maintenance remission of immune mediated disease with glucocorticoids, after induction of remission?
Keep at same dose (2mg/kg dog, 3-4mg/kg cat) but every 48 hours. Start on non-steroidal immunosuppressants (azothioprine (dog 50mg/m2), chlorambucil (cat 2mg/cat) every other day. Taper over 2-4 weeks.
