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Pharmacology of Glucocorticoids: Uses, Effects, & Dosage

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  1. Chapter 72 Glucocorticoids in Nonendocrine Disorders

  2. GlucocorticoidDrugs (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

  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

  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

  5. Fig.72–1. Feedback regulation of glucocorticoid synthesis and secretion.

  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 • Psychologicdisturbances (mania or depression)

  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

  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

  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

  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)

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