adrenal agents. women’s health agents. men’s health agents

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