1. Adrenal Agents. Women’s Health Agents. Men’s Health Agents.

3. Corticosteroids Adrenal glands produce glucocorticoids and mineralocorticoids Glucocorticoids: – Involved in cholesterol, fat, and protein metabolism Mineralocorticoids: – Involved in regulating electrolyte and water balance

4. Cortisol Principal adrenal steroid hormone Responsible for: – Gluconeogenesis – Protein catabolism – Anti-inflammatory reactions – Stimulation of fat deposition – Sodium and water retention

5. Corticosteroids Adrenal hormones excluding sex hormones Steroid production follows a circadian rhythm

6. Properties of glucocorticosteroides used in clinics Anti-inflammatory Immune-depressive Anti-allergic Anti-shock Anti-toxic

7. Anti-inflammatory action of GCS Nonspecific inflammation Auto-immune component Hyperergic character Therapy of despair

8. Mechanism of anti-inflammatory action of GCS GCS activation of lipomoduline decreasing of activity of phospholipase А 2 slowing down of arachidonic acid metabolites production (prostaglandins, leucotriens, thromboxan А 2 ) stabilization of cellular and lyzosomal membranes decreasing of leucocytes’ migration processes, depression of phagocytes activity decreasing of capillaries’ wall permeability depression of histamine, serotonin, bradykinine releasing

9. Indications for administration of GCS Insufficiency of adrenal cortex Rheumatoid illnesses (rheumatoid arthritis, rheumatism, system red lupus etc.) Chronic active hepatitis Bronchial asthma Ulcerative colitis Nephritic syndrome Auto-immune hemolytic anemia Shock and collapse of any etiology Brain, lungs, larynx edema Acute allergic reactions Transfusion reactions Heavy infections (hiding behind the etiotropic drugs!) Liver disesaes

11. Doses and terms of GCS therapy Situation Daily dose Terms of treatment Acute cases (shock, collapse, brain, lungs edema, septic shock, asthmatic condition etc.) 200-500- 800-1000 mg i.v. 1-3 days Subacute and acute attacks of chronic processes (rheumatoid diseases, ulcerative colitis, bronchial asthma etc.) 20-50 mg (rarely till 200 mg) 4-6 weeks- several months Primary and secondary insufficiency of adrenal cortex 2,5-10 mglife-long

12. Corticosteroids Act as anti-inflammatory and immunosuppressive agents in treating diseases of different origins: – Hematologic – Allergic – Inflammatory – Neoplastic – Autoimmune

13. Administration of GCS Insufficiency of adrenal cortex Rheumatoid illnesses (rheumatoid arthritis, rheumatism, system red lupus etc.) Chronic active hepatitis Bronchial asthma Ulcerative colitis Nephritic syndrome Auto-immune hemolytic anemia Shock and collapse of any etiology Brain, lungs, larynx edema Acute allergic reactions Transfusion reactions Heavy infections (hiding behind the etiotropic drugs!) Liver diseases

14. Doses and terms of GCS therapy Situation Daily dose Terms of treatment Acute cases (shock, collapse, brain, lungs edema, septic shock, asthmatic condition etc.) 200-500- 800-1000 mg i.v. 1-3 days Subacute and acute attacks of chronic processes (rheumatoid diseases, ulcerative colitis, bronchial asthma etc.) 20-50 mg (rarely till 200 mg) 4-6 weeks- several months Primary and secondary insufficiency of adrenal cortex 2,5-10 mg life-long

15. Hydrocortisone acetate

16. Prednisolone

17. Becotide = Beclometh (beclomethasone dipropionate)

18. Kenalog (triamcinolone acetonide)

19. Dexamethasone

21. Complications of GCS-therapy

22. Izenko-Cushing’ssyndrome

24. MINERALOCORTICOIDS Desoxycorticosterone acetate - DOXA Mode of action Mode of action Acts on kidney tubules: causes the reabsorption of sodium and water, decreases the reabsorption of potassium, regulates fluid-electrolyte metabolism, increases AP, enhances muscle work regulates fluid-electrolyte metabolism, increases AP, enhances muscle work Administration Administration For chronic adrenal insufficiency (Addison’s disease), myasthenia, adynamia Side effects Side effects edema, AP increasing, pulmonary edema, cardiac insufficiency edema, AP increasing, pulmonary edema, cardiac insufficiency

25. Glucocorticoids + mineralocorticoids

26. Drugs of female sex hormones Estrogens estron (oil solution of folliculin) estradiol ethynilestradiol (microfollin) synestrol Gestagens progesterone oxyprogesterone caproate alilestrenol (turinal)

28. Ovarian-menstrual cycle

31. Administration of drugs of female sex hormones estrogens 1) Genital hypoplasia, primary and secondary amenorrhea 2) Sexual underdevelopment of women 3) After ovary-ectomia 4) Climacteric disorders 5) Lactation depression 6) Weak labor activity (estrogen background) 7) Prostate cancer of men, breast cancer of women after the age of 60 8) A part of contraceptive agents

32. Sites of Action of the Estrogens

33. Administration of drugs of female sex hormonesestrogens 1) Genital hypoplasia, primary and secondary amenorrhea 2) Sexual underdevelopment of women 3) After ovary-ectomia 4) Climacteric disorders 5) Lactation depression 6) Weak labor activity (estrogen background) 7) Prostate cancer of men, breast cancer of women after the age of 60 8) A part of contraceptive agents

34. Effects of Progesterone on the Body Decreased uterine motility Development of secretory endometrium Thickened cervical mucus Breast growth Increased body temperature Increased appetite Depressed T-cell function Anti-insulin effect

35. Hormonal contraceptives 1) combined estrogen-gestagen a) monophased (bisecurin, non-ovlon, rigevidon, marvelon, demulen) b) double-phased (anteovin, neo-eunomin) c) triple-phased (tri-regol, trisiston) 2) monohormonal gestagen (mini-pilli) exluton, ovret, continuin 3) postcoital hestagen (postinor) 4) depot-contraceptives - of prolonged action norplant (levonorgestrel) depot-provera (medroxyprogesterone acetate)

36. Administration of gestagen drugs 1) miscarriage, habitual abortion 2) dysfunctional uterus bleedings, algomenorrhea 3) as component of contraceptives 4) Climacteric disorders

37. Administration of gestagens 1) miscarriage, habitual abortion 2) dysfunctional uterus bleedings, algomenorrhea 3) as component of contraceptives 4) Climacteric disorders 5) As part of fertility programs 6) Treat specific cancers with specific receptor site sensitivity

38. hypertension hypercoagulation dyspeptic disorders (nausea, vomiting) migraine depression obesity cholestatic jaundice breast cancer, cancer of uterus cervix ischemic heart disease myocardium infarction stroke embryotoxic and teratogenic action thrombo-embolia Complications in case of administration of hormonal contraceptives

40. Antiestrogen drugs

41. ANABOLIC STEROIDS ANABOLIC STEROIDS Phenobolinum, Retabolil, Methandrostenolonum PHARMACOLOGICAL EFFECTS -Stimulation of protein synthesis -Depression of phosphor and Ca ++ excretion -Increase of bones, muscles and parenchymatous organs mass -Stimulation of regenerationADMINISTRATION -Aplastic anemia (bone marrow suppression) -Osteoporosis, bone fractures -Exhausted diseases -Prolonged treatment with GCS

42. COMPLICATIONS Hepatitis, sexual disorders (impotence), edemas, masculinization, nausea, vomiting, Sudden death