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

• 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

Glucocorticoids Most glucocorticoids are synthetic analogues of hormones secreted by the adrenal cortex: • beclomethasone • betamethasone • cortisone • dexamethasone • hydrocortisone • methylprednisolone • prednisolone • prednisone • triamcinolone. sh.alinia

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

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

…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

Pharmacotherapeutics replacement therapy for patients with adrenocortical insufficiency, glucocorticoids are prescribed for immunosuppression and reduction of inflammation. sh.alinia

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

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

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

Pharmacokinetics Fludrocortisone acetate is metabolized in the liver to inactive metabolites. .The drug is excreted by the kidneys. sh.alinia

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

Pharmacotherapeutics Fludrocortisone acetate is used as replacement therapy for patients with adrenocortical insufficiency . sh.alinia

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