1. Glucocorticoids in Nonendocrine Disorders
Chapter 72
Glucocorticoids in Nonendocrine Disorders 1

2. 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

3. 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

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 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