Glucocorticoids in Nonendocrine Disorders Chapter 72 Glucocorticoids in Nonendocrine Disorders 1

Glucocorticoid Drugs (familiar names are Prednisone, Prednisolone) Also known as corticosteroids and nearly identical to steroids produced by the adrenal cortex Physiologic effects (low doses) Modulation of glucose metabolism in adrenocortical insufficiency Pharmacologic effects (high doses) Suppression of inflammation 2

Pharmacology of Glucocorticoids Effects on metabolism and electrolytes Anti-inflammatory and immunosuppressant effects Therapeutic uses in nonendocrine disorders Rheumatoid arthritis Systemic lupus erythematosus Inflammatory bowel disease Miscellaneous inflammatory disorders 3

Pharmacology of Glucocorticoids Therapeutic uses in nonendocrine disorders (cont’d) Allergic conditions Asthma Dermatologic disorders Neoplasms Suppression of allograft rejection Prevention of respiratory distress syndrome 4

ACTH = adrenocorticotropic hormone; CNS = central nervous system; CRH = corticotropin-releasing hormone. Fig. 72–1. Feedback regulation of glucocorticoid synthesis and secretion. 5

Pharmacology of Glucocorticoids Adverse effects Adrenal insufficiency (can have “crisis” if body is severely stressed) Osteoporosis and resultant fractures Infection (fever, sore throat, etc, more concerning) Glucose intolerance- diabetes have trouble with glycemic control Myopathy Fluid and electrolyte disturbances- edema, HTN, hypokalemia Growth retardation (growth slowed for one year in kids Psychologic disturbances (mania or depression) 6

Pharmacology of Glucocorticoids Adverse effects (cont’d) Cataracts and glaucoma Peptic ulcer disease Iatrogenic Cushing’s syndrome Use in pregnancy and lactation Drug interactions Interactions related to potassium loss Nonsteroidal anti-inflammatory drugs (ulcer risk) Insulin and oral hypoglycemics Vaccines 7

Pharmacology of Glucocorticoids Contraindications Patients with systemic fungal infections Latent tuberculosis Those receiving live virus vaccines Use with caution in pediatric patients and in pregnancy/breast-feeding 8

Pharmacology of Glucocorticoids Adrenal suppression Why it can develop Adrenal suppression and physiologic stress Glucocorticoid withdrawal Taper the dosage over 7 days (to physiologic dosage) Switch from multiple doses to single doses Taper the dosage to 50% of physiologic values (for another month) Monitor for signs of insufficiency 9

Glucocorticoid Dosage Highly individualized Determined empirically (trial and error) 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 (“stress dose,” for example, pre-op, may be triple and given IV) Gradual weaning Alternate-day therapy (less adrenal suppression) 10