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_-Chapter 16 Cholinesterase Inhibitors

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Chapter 72
Glucocorticoids in Nonendocrine Disorders
GlucocorticoidDrugs (familiar names are Prednisone,Prednisolone)
Also known ascorticosteroidsandnearly identical to steroids produced by the adrenal cortexPhysiologic effects (low doses)Modulation of glucose metabolism in adrenocortical insufficiencyPharmacologic effects (high doses)Suppression of inflammation
Pharmacology of Glucocorticoids
Effects on metabolism and electrolytesAnti-inflammatory and immunosuppressant effectsTherapeutic uses in nonendocrine disordersRheumatoid arthritisSystemic lupus erythematosusInflammatory bowel diseaseMiscellaneous inflammatory disorders
Pharmacology of Glucocorticoids
Therapeutic usesin nonendocrine disorders (cont’d)Allergic conditionsAsthmaDermatologic disordersNeoplasmsSuppression ofallograft rejectionPrevention of respiratory distress syndrome
Fig.72–1. Feedback regulation of glucocorticoid synthesis and secretion.
Pharmacology of Glucocorticoids
Adverse effectsAdrenalinsufficiency (can have “crisis” if body is severely stressed)Osteoporosisand resultant fracturesInfection (fever, sore throat, etc, more concerning)Glucoseintolerance- diabetes have trouble withglycemiccontrolMyopathyFluid and electrolytedisturbances- edema, HTN,hypokalemiaGrowthretardation (growth slowed for one year in kidsPsychologicdisturbances (mania or depression)
Pharmacology of Glucocorticoids
Adverse effects (cont’d)Cataracts and glaucomaPeptic ulcer diseaseIatrogenic Cushing’s syndromeUse in pregnancy and lactationDrug interactionsInteractions related topotassium lossNonsteroidal anti-inflammatorydrugs (ulcer risk)Insulin and oral hypoglycemicsVaccines
Pharmacology of Glucocorticoids
ContraindicationsPatients with systemicfungalinfectionsLatent tuberculosisThose receiving live virus vaccinesUse with caution in pediatric patients and in pregnancy/breast-feeding
Pharmacology of Glucocorticoids
Adrenal suppressionWhy it can developAdrenal suppression and physiologic stressGlucocorticoid withdrawalTaperthe dosage over7days (to physiologic dosage)Switch from multiple doses to single dosesTaper the dosage to 50% of physiologicvalues (for another month)Monitor for signs of insufficiency
Glucocorticoid Dosage
Highly individualizedDetermined empirically (trial and error)No immediate threat—start low and slowImmediate threat—start high; decrease as possibleLong-time use—smallest effective amountProlonged treatment with high doses only if disorder is life-threatening or has potential to cause permanent disabilityIncreased in times ofstress (“stress dose,” for example, pre-op, may be triple and given IV)Gradual weaningAlternate-daytherapy (less adrenal suppression)

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_-Chapter 16 Cholinesterase Inhibitors