adrenal agents. women’s health agents. men’s health agents
TRANSCRIPT
Adrenal Agents. Women’s Health Agents. Men’s Health
Agents.
Corticosteroids
• Adrenal glands produce glucocorticoids and mineralocorticoids
• Glucocorticoids:– Involved in cholesterol, fat, and protein
metabolism
• Mineralocorticoids:– Involved in regulating electrolyte and water
balance
Cortisol
• Principal adrenal steroid hormone• Responsible for:– Gluconeogenesis– Protein catabolism– Anti-inflammatory reactions– Stimulation of fat deposition– Sodium and water retention
Corticosteroids
• Adrenal hormones excluding sex hormones• Steroid production follows a circadian rhythm
Properties of glucocorticosteroides used in clinics
• Anti-inflammatory• Immune-depressive
• Anti-allergic• Anti-shock• Anti-toxic
Anti-inflammatory action of GCS
• Nonspecific inflammation • Auto-immune component• Hyperergic character• Therapy of despair
Mechanism of anti-inflammatory action of GCS
GCS
activation of lipomoduline
decreasing of activity of phospholipase А2
slowing down of arachidonic acid metabolites production
(prostaglandins, leucotriens, thromboxan А2)
stabilization of cellular and
lyzosomalmembranes
decreasing of leucocytes’
migration processes, depression of
phagocytes activity
decreasing of capillaries’ wall permeability
depression of histamine, serotonin, bradykinine releasing
Indications for administration of GCS• Insufficiency of adrenal cortex • Rheumatoid illnesses (rheumatoid arthritis, rheumatism, system red
lupus etc.)• Chronic active hepatitis• Bronchial asthma • Ulcerative colitis• Nephritic syndrome• Auto-immune hemolytic anemia• Shock and collapse of any etiology• Brain, lungs, larynx edema• Acute allergic reactions • Transfusion reactions• Heavy infections (hiding behind the etiotropic drugs!)• Liver disesaes
Doses and terms of GCS therapy
Situation Situation Daily doseDaily dose Terms of Terms of treatmenttreatment
Acute cases (shock, collapse, brain, lungs edema, septic shock, asthmatic condition etc.)
200-500-800-1000 mg i.v.
1-3 days
Subacute and acute attacks of chronic processes (rheumatoid diseases, ulcerative colitis, bronchial asthma etc.)
20-50 mg(rarely till 200 mg)
4-6 weeks-several months
Primary and secondary insufficiency of adrenal cortex
2,5-10 mg life-long
Corticosteroids
• Act as anti-inflammatory and immunosuppressive agents in treating diseases of different origins:– Hematologic– Allergic– Inflammatory– Neoplastic– Autoimmune
Administration of GCS• Insufficiency of adrenal cortex • Rheumatoid illnesses (rheumatoid arthritis, rheumatism,
system red lupus etc.)• Chronic active hepatitis• Bronchial asthma • Ulcerative colitis• Nephritic syndrome• Auto-immune hemolytic anemia• Shock and collapse of any etiology• Brain, lungs, larynx edema• Acute allergic reactions • Transfusion reactions• Heavy infections (hiding behind the etiotropic drugs!)• Liver diseases
Doses and terms of GCS therapy
Situation Situation Daily doseDaily dose Terms of Terms of treatmenttreatment
Acute casesAcute cases ( (shock, shock, collapse, brain, lungs collapse, brain, lungs edema, septic shock, edema, septic shock, asthmatic condition asthmatic condition etc.etc.))
200-500-200-500-800-1000 800-1000 mg i.v.mg i.v.
1-3 1-3 daysdays
Subacute and acute Subacute and acute attacks of chronic attacks of chronic processesprocesses ( (rheumatoid rheumatoid diseases, ulcerative diseases, ulcerative colitis, bronchial colitis, bronchial asthma etc.asthma etc.))
20-50 20-50 mgmg((rarely tillrarely till 200 200 mgmg))
4-6 4-6 weeksweeks--several several monthsmonths
Primary and Primary and secondary secondary insufficiency of insufficiency of adrenal cortexadrenal cortex
2,5-10 2,5-10 mgmg life-longlife-long
Hydrocortisone acetate
Prednisolone
Becotide = Beclometh(beclomethasone dipropionate)
Kenalog(triamcinolone acetonide)
Dexamethasone
Complications of Complications of GCS-therapyGCS-therapy
Izenko-Cushing’s Izenko-Cushing’s syndromesyndrome
MINERALOCORTICOIDSMINERALOCORTICOIDSDesoxycorticosterone acetate - DOXADesoxycorticosterone acetate - DOXA
• Mode of actionMode of action Acts on kidney tubules: causes the reabsorption of sodium and Acts on kidney tubules: causes the reabsorption of sodium and
water, decreases the reabsorption of potassium,water, decreases the reabsorption of potassium, regulates fluid-electrolyte metabolism, increases AP, enhances regulates fluid-electrolyte metabolism, increases AP, enhances
muscle workmuscle work• AdministrationAdministration
For chronic adrenal insufficiency (Addison’s disease), For chronic adrenal insufficiency (Addison’s disease), myasthenia, adynamiamyasthenia, adynamia
• Side effectsSide effects edema, AP increasing, pulmonary edema, cardiac insufficiencyedema, AP increasing, pulmonary edema, cardiac insufficiency
Glucocorticoids + mineralocorticoidsGlucocorticoids + mineralocorticoids
Drugs of female sex Drugs of female sex hormoneshormones
Estrogens Estrogens
estron(oil solution of folliculin)estradiolethynilestradiol(microfollin)synestrol
Gestagens Gestagens
progesteroneoxyprogesterone caproatealilestrenol (turinal)
Ovarian-menstrual cycleOvarian-menstrual cycle
Administration of drugs Administration of drugs of female sex hormonesof female sex hormones
estrogensestrogens
1) Genital hypoplasia, primary and secondary amenorrhea2) Sexual underdevelopment of women3) After ovary-ectomia4) Climacteric disorders 5) Lactation depression6) Weak labor activity(estrogen background)7) Prostate cancer of men, breast cancer of women after the age of 608) A part of contraceptive agents
Sites of Action of the Estrogens
Administration of drugs of female sex hormones
estrogensestrogens
1) Genital hypoplasia, primary and secondary amenorrhea2) Sexual underdevelopment of women3) After ovary-ectomia4) Climacteric disorders 5) Lactation depression6) Weak labor activity(estrogen background)7) Prostate cancer of men, breast cancer of women after the age of 608) A part of contraceptive agents
Effects of Progesterone on the Body
• Decreased uterine motility• Development of secretory endometrium• Thickened cervical mucus• Breast growth• Increased body temperature• Increased appetite• Depressed T-cell function• Anti-insulin effect
Hormonal contraceptives
1) combined estrogen-gestagen a) monophased (bisecurin, non-ovlon, rigevidon,
marvelon, demulen) b) double-phased (anteovin, neo-eunomin)
c) triple-phased (tri-regol, trisiston)2) monohormonal gestagen (mini-pilli)
exluton, ovret, continuin3) postcoital hestagen (postinor)
4) depot-contraceptives - of prolonged action norplant (levonorgestrel)
depot-provera (medroxyprogesterone acetate)
Administration of Administration of gestagen drugsgestagen drugs
1) miscarriage, habitual
abortion
2) dysfunctional uterus
bleedings, algomenorrhea
3) as component of
contraceptives
4) Climacteric disorders
Administration of gestagens
1) miscarriage, habitual abortion
2) dysfunctional uterus bleedings, algomenorrhea
3) as component of contraceptives
4) Climacteric disorders5) As part of fertility programs
6) Treat specific cancers with specific receptor site sensitivity
hypertension hypercoagulationdyspeptic disorders (nausea, vomiting)migraine depressionobesitycholestatic jaundicebreast cancer, cancer of uterus cervixischemic heart diseasemyocardium infarctionstrokeembryotoxic and teratogenic action
thrombo-emboliathrombo-embolia
Complications in case of administration ofhormonal contraceptives
Antiestrogen drugs
ANABOLIC STEROIDSANABOLIC STEROIDSPhenobolinum, Retabolil, Methandrostenolonum
PHARMACOLOGICAL EFFECTSPHARMACOLOGICAL EFFECTS- Stimulation of protein synthesis- Depression of phosphor and Ca++ excretion- Increase of bones, muscles and parenchymatous organs
mass- Stimulation of regeneration
ADMINISTRATIONADMINISTRATION- Aplastic anemia (bone marrow suppression)- Osteoporosis, bone fractures- Exhausted diseases- Prolonged treatment with GCS
COMPLICATIONSCOMPLICATIONS
Hepatitis, sexual Hepatitis, sexual disorders disorders
(impotence), (impotence), edemas, edemas,
masculinization, masculinization, nausea, vomiting,nausea, vomiting,
Sudden deathSudden death