Peptic ulcer by 2l4RYZ

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									Pharmacology                                                           Dr.M.Hassan


                                  Corticosteroids
Corticosteroids have very wide clinical application and used for many conditions.
They are naturally produced in the body from the adrenal cortex as 2 types:
Mineral corticosteroids: affect the water retention more than metabolism.
Glucocorticoids: affect metabolism more than water retention.
Pharmacological effects of Corticosteroids:
   1) Immunosuppression:
They affect mostly T cells and plasma cells.
   2) Anti-inflammation:
They inhibit prostaglandin formation by inhibiting the enzyme phospholipase A.
Normally, phospholipase A results in the formation of arachidonic acid which then
used to form prostaglandins. Because of the inhibition of prostaglandin formation,
corticosteroids may result in peptic ulcer.
   3) Cause Na & water retention.
   4) They affect metabolism:
            They increase glucose level in blood.
            They cause fat redestribution.
            They promote the catabolism of proteins, which cause muscle waste.
                They interfere with calcium absorption which predispose to
                osteoarthritis.
            They may also cause growth retardation.
Clinical uses of corticosteroids:
   1. In autoimmune diseases, such as SLE, myasthenia gravis.
   2. Inflammatory diseases such as ulcerative colitis.
   3. In transplantation: to suppress immune reaction.
   4. They are used in Edison’s disease.
Corticosteroids are not used in diabetic (they increase blood glucose) or hypertensive
(they cause Na and water retention), but they can be used in asthmatic patients.
Side Effects:
Peptic ulcer, infection, obesity, muscle waste, hypertension, Diabetes, osteoporosis,
mild psychosis and may cause some effects on sex characteristics.




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Pharmacology                                                              Dr.M.Hassan


Their side effects appear in long-term use, but the chance of having them is high
compared with NSAIDs, because these hormones are already present in the body. The
development of side effects depends also on the dose used.
They do not cause dependence like morphine, but people get used to use it. They also
do not cause sedation. They are not severe teratogenic, but not used in pregnancy.
Steroids are also used topically for local inflammation. However, side effects may
also result from the topical use. Besides the route of administration, systemic effects
also depend on the percentage of corticosteroids in preparation. But still the topical
used causing less systemic effects than the systemic use.
How can we lessen the side effects?
Changing the route of administration as possible.
Manage the dose and duration of use. We try to give doses in balance with what is
produced in the body, give the drug in the morning to mimic the normal peak of the
hormone. We also try to give one large dose and then stop it or give large doses for
short time and then stop it. However, this cannot be applied in all patients.
We can also alternate with other drugs, but difficult to do it in clinical practice.
Metabolism of corticosteroids:
They are metabolized by the liver, excreted by the kidney. Bind to plasma protein
called transcortin.
Examples of Corticosteroids:
   1. Hydrocortisone (cortisone)(inactive), converted to cortisol (active).
   Naturally occurring, strong anti-inflammatory activity. Has some mineralo-
   activity, not used in hypertension. Used as immunosuppressive.
   2. Prednisone (inactive), converted to prednisolone (active).
   Is synthetic. Strong anti-inflammatory. Has negligible mineralo-activity. Used as
   immunosuppressive.
   3. Dexamethasone.
   Good anti-inflammatory.
   4. Beclomethasone.
   Good anti-inflammatory.
   5. Fludrocortisone.
   Has no anti-inflammatory activity. Is similar to aldosterone.
   Drugs #3,4,5 are synthetic.
                                             By: A.O. B. http://www.4medstudents.com


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