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Endocrine Drugs
 
 
 

Glucocorticoids

 
 
  •  
    IV / Oral
    Prednisolone / Prednisone
    Panafcort, Predsone, Sone 
  •  
    IV / Topical
    Hydrocortisone
    Cortef 

Overview

  • Glucocorticoids such as hydrocortisone and prednisolone are used to replace deficient endogenous steroid in the context of adrenocortical insufficiency.
    • Mechanism of Action

      Suppress the body's normal inflammatory response through:
    • Reduced monocyte recruitment
    • Suppression of arachidonic acid metabolites - prostaglandin, leukotriene, platelet-activating factor
    • Reduced production of interleukins, TNF-α, GM-CSF
    • Non-Inflammatory Effects of Corticosteroids

    • Increased circulating glucose - ↑gluconeogenesis, ↓glucose usage
    • Redistribution of fats - in face, neck, shoulder
    • ↓ Absorption of Ca²⁺
    • Muscle homeostasis

Clinical Use

    • Indications

    • Replacement therapy for adrenocortical insufficiency
    • Acute asthma
    • Exacerbations of COPD
    • Croup
    • Other inflammatory conditions - dermatitides, ulcerative colitis, autoimmune haemolytic anaemia, acute gout, rheumatoid arthritis, seronegative arthritides, systemic lupus erythematosus, polyarteritis nodosa
    • Cerebral oedema
    • Nephrotic syndrome
    • Immunosuppression post organ transplant
    • Adverse Effects

    • Immunosuppression (risk of infection)
    • Osteoporosis
    • Steroid-induced diabetes mellitus
    • Cushing’s - central obesity, ‘moon’ face, buffalo hump, thin skin, peripheral oedema, striae, bruising
    • CNS - cognitive impairment / emotional instability / fatigue
    • Renal - sodium & water retention / hypertension / oedema
    • GIT - peptic ulceration, nausea / vomiting
    • Muscle wasting
    • Ocular - cataract / glaucoma
    • Signs of Withdrawal

    • Worsening of underlying disease
    • Acute adrenal insufficiency
    • Raised ICP / papilloedema
    • Avoiding Withdrawal

    • Taper the dose by 2.5-5mg prednisone every 3-7 days prior to ceasing.
  • Give in the morning between 6-10am in order to mimic the normal diurnal cycle
Last updated on January 1st, 2017
 
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The information in this section has been adapted in part from the Australian Therapeutic Goods Association website's repository of product information documents, which are available at https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/PICMI.
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