Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 72 Glucocorticoids in Nonendocrine Disorders

Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Chapter 72

Glucocorticoids in Nonendocrine Disorders

Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 2

Glucocorticoid Drugs

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


Glucocorticoids in Nonendocrine Disorders

Glucocorticoid physiology Metabolic effects Cardiovascular effects Effects during stress Effects on water and electrolytes Respiratory system in neonates


Pharmacology of Glucocorticoids

Molecular mechanisms of action different from those of other drugs Glucocorticoid receptors are inside the cell Glucocorticoids modulate the production of

regulatory proteins vs. signaling pathways



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



Therapeutic uses in nonendocrine disorders (cont’d) Allergic conditions Asthma Dermatologic disorders Neoplasms Suppression of allograft rejection Prevention of respiratory distress syndrome


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



Adverse effects Adrenal insufficiency Osteoporosis and resultant fractures Infection Glucose intolerance Myopathy Fluid and electrolyte disturbances Growth retardation Psychologic disturbances



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 Insulin and oral hypoglycemics Vaccines



Contraindications Patients with systemic fungal infections Those receiving live virus vaccines Use with caution in pediatric patients and in

pregnancy/breast-feeding



Adrenal suppression Why it can develop Adrenal suppression and physiologic stress Glucocorticoid withdrawal

• Taper the dosage over 7 days• Switch from multiple doses to single doses• Taper the dosage to 50% of physiologic values• Monitor for signs of insufficiency


Glucocorticoid Routes of Administration

Oral, parenteral (IV, IM, subQ), and topical Individual glucocorticoids differ in three ways:

Biologic half-life Mineralocorticoid potency Glucocorticoid potency


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 Gradual weaning Alternate-day therapy

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Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 72 Glucocorticoids in Nonendocrine Disorders