VPHM 142 Glucocorticoids

Classes of corticoids according to actiivity

Glucocorticoids

Mineralocorticoids

Adrenal sex hormones

Glucocorticoids

control carbohydrate, fat and protein metabolism, and are anti-inflammatory and immunosuppressive

Mineralocorticoids

Regulate electrolyte and water levels in the body, mainly by promoting Na retention in the kidney

Natural corticosteroids

Hormones produced by the adrenal cortex

clinically used corticoids

synthetic analogues of natural hormones

Physiological effects of GCC

Restore balance in the body during periods of stress or injury

1. Control carbohydrate, protein and fat metabolism in favor of promoting high levels of glucose in the blood

2. control inflammatory reaction

3. control immune response

Control carbohydrate, protein and fat metabolism to increase blood glucose levels

Increase the rate of gluconeogenesis

reduce protein synthesis

catabolic effect on muscles

allows lipolysis to occur

Anti-inflammatory effect

prevents breakdown of cell membranes by phospholipase

No vasoactive inflammatory mediators are synthesized/released

Clinical uses: Anti-inflammatory

inflammatory conditions of the muscoskeletal system

allergic reactions

laminitis

inflammatory ocular conditions such as conjunctivitis and uveitis

shock/toxemia

asthma

inflammatory bowel

Immunosuppressive mechanism

Inhibit antibody formation

decrease lymphocyte and eosinophil concentrations

suppress migration of neutrophils

inhibit phagocytosis

Clinical use: immunosuppressive

Lymphocytic neoplasm - GCCs induce the apoptosis of malignant lymphoid cells

Clinical uses: Replacement

Addison’s disease

Classification of GCCs according to duration of action

Short acting

intermediate acting

long acting

Dosage forms

Injectable

Oral

topical

inhaled

fluticasone propionate

long acting GCC that has been used in feline asthma

Adverse effect: Control carbohydeare, protein and fat metabolism to increase blood glucose levels

*thinning of the skin and muscle wasting (due to conversion of protein to glucose)

depressed healing

muscle wasting

polyphagia and resultant weight gain

diabetes

Adverse side effect: control inflammatory response

Gastric ulceration

bruising/bleeding tendencies

high blood pressure

adverse side effect: control immune system

infection

other adverse side effects

behavioral changes

vision changes

brittle bones

cushing disease

Iatrogenic hypoadrenocorticism

Cushing’s syndrome

a slowly progressive disease where the presence of chronically high levels of cortisol of GCC cause changes in the body

How to avoid adverse effects

Alternate day therapy dosing