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regub 16: steroid pharmacology - use of synthetic agents (Androgens…
regub 16: steroid pharmacology - use of synthetic agents
synthetic steroids
chemical modification of natural steroids
have higher affinity for Rs
can separate glucocorticoid from mineralocorticoid actions by switching off genes
glucocorticoids
uses
decrease swelling (oedema)
decrease immune response (lupus + transplants)
inhibits COX2, cytokines, ILs, adhesion molecules, NO synthase, eicosanoids (make PGs)
decrease plasma conc of C proteins
decrease terminal pain
HRT (e.g. in Addison's)
oral admin most active
also given IV,IM,inhaled,creams,eye/nose drops
decrease inflamm (asthma + arthritis)
effective is early + late manifestations
decrease T helper activation
increase osteoclast activity, decrease osteoblast activity
switch off genes for autoimmunity
e.g: prednisone, fludrocortisone, dexamethasone, betamethasone
adverse effects
less endogenous production
reduced response to infection
osteoporosis
cushing's syndrome
diabetes
pit tumour -> emotional disturbances
Addison's treatment
1st line = hydrocortisone
2nd line = fludrocortisone
mineralcorticoids
e.g. fludrocortisone
used in HRT
adverse effects
Na+/K+ ratio disturbance
Androgens
same effects as endogenous testosterone
can't be given orally (1st pass metabolism
antiandrogens treat prostatic cancer
use = HRT
in males for hypogonadism due to pit/testicular disease
in females for hyposexuality due to ovariectomy
adverse effects
oedema
infertility
liver tumours
impaired growth in kids
acne
masculinisation (girls)
sudden withdrawal of corticosteroids
acute adrenal insufficiency -> adrenal crisis
steroids can't be made endogenously
requires phased withdrawal for 12-18 months
anabolic steroids
e.g. nandrolone
chemical modification of androgens
abused - CAD,liver tumours,cholestatic jaundice