Corticosteroids

Corticosteroids• Corticosteroids suppress immune responses

and reduce inflammation.• available as natural or synthetic steroids.• Natural corticosteroids are hormones

produced by the adrenal cortex;• Natural and synthetic corticosteroids are

classified according to their biological activities:

sh.alinia 2

• • Glucocorticoids, such as cortisone acetate and dexamethasone,affect carbohydrate and protein metabolism.

• • Mineralocorticoids, such as aldosterone and fludrocortisone acetate,regulate electrolyte and water balance.

sh.alinia 3

Glucocorticoids• Most glucocorticoids are synthetic analogues of

hormones secreted by the adrenal cortex:• • beclomethasone• • betamethasone• • cortisone• • dexamethasone• • hydrocortisone• • methylprednisolone• • prednisolone• • prednisone• • triamcinolone.

sh.alinia 4

Pharmacokinetics

• Glucocorticoids are well absorbed when administered orally.

• After I.M. administration, they’re absorbed completely.

• Glucocorticoids are metabolized in the liver and excreted by the kidneys.

sh.alinia 5

Pharmacodynamics• Glucocorticoids suppress

hypersensitivity and immune responses through a process that isn’t entirely understood.

• Researchers believe that glucocorticoids inhibit immune responses by:• • suppressing or preventing cell-mediated immune reactions• • reducing levels of leukocytes, monocytes, and eosinophils• • decreasing the binding of immunoglobulins to cell surface receptors

sh.alinia 6

…Pharmacodynamics- Glucocorticoids suppress the redness, edema,

heat, and tenderness associated with the inflammatory response.

- prevent the leakage of plasma from capillaries, suppress the migration of polymorphonuclear leukocytes (cells that kill and digest microorganisms), and inhibit phagocytosis (ingestion and destruction).

- decrease antibody formation in injured or infected tissues .

sh.alinia 7

Pharmacotherapeutics

• replacement therapy for patients with adrenocortical insufficiency, • glucocorticoids are prescribed for

immunosuppression and reduction of inflammation.

sh.alinia 8

Adverse reactions to corticosteroids

• • insomnia• • increased sodium and water retention• • increased potassium excretion• • suppressed immune and inflammatory responses• • osteoporosis• • intestinal perforation• • peptic ulcers• • impaired wound healing.

sh.alinia 9

• Endocrine system reactions may include:• • diabetes mellitus• • hyperlipidemia• • adrenal atrophy• • hypothalamic-pituitary axis suppression• • cushingoid signs and symptoms (such as buffalo

hump,moon face, and elevated blood glucose levels).

nursing- Administer drug daily at 8 to 9 am to mimic normal peak

diurnal concentration levels and thereby minimize suppression of the hypothalamic–pituitary axis.

- Use the minimal dose for the minimal amount of time to minimize adverse effects.

- Taper doses when discontinuing from high doses or from long-term therapy .

- Do not give live virus vaccines when the patient is immunosuppressed because there is an increased risk of infection.

- Protect the patient from exposure to infection .

sh.alinia 11

Mineralocorticoids• Mineralocorticoids affect electrolyte and

water balance. These drugs include:• • fludrocortisone acetate, a synthetic

analogue of hormones secreted by the adrenal cortex

• • aldosterone, a natural mineralocorticoid (the use of which has been curtailed by high cost and limited availability).

sh.alinia 12

Pharmacokinetics

• Fludrocortisone acetate is metabolized in the liver to inactive metabolites.

• .The drug is excreted by the kidneys.

sh.alinia 13

Pharmacodynamics

• Fludrocortisone acetate affects fluid and electrolyte balance by acting on the distal renal tubule to increase sodium reabsorption and potassium and hydrogen secretion.

sh.alinia 14

Pharmacotherapeutics

• Fludrocortisone acetate is used as replacement therapy for patients with adrenocortical insufficiency .

sh.alinia 15

Implementation With Rationale

- Monitor for hypokalemia.- Discontinue if signs of overdose (excessive

weight gain, edema, hypertension, cardiomegaly) occur to prevent the development of more severe toxicity.

sh.alinia 16