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sqadia.com offers variety of medical lectures on the medical subject of pharmacology. In this lecture of adrenocortical agonists and antagonists, experienced pharmacist sheds light on the adrenocorticosteroids, how Addison’s disease and Cushing syndrome are associated with adrenocorticosteroids and some non-adrenal disease such as rheumatic disorders, ocular disease, nephrotic syndrome. Subsequently, Sidra Afzal gives important information metyrapone, aminoglutethimide, and ketoconazole as antagonists of adrenocortical agents.
Adrenocorticosteroids are compounds created by the adrenal cortex that have distant metabolic effects. The adrenocorticosteroids can be divided into two major groups: the glucocorticoids and the mineralocorticoids. The mechanism of action of the steroids involves binding to a specific receptor and forming a steroid-receptor complex. The complex then translocates into the nucleus and alters gene expression. Contraindications of adrenocorticosteroids are peptic ulcer, heart disease, psychoses, osteoporosis.
Adrenal insufficiency, including Addison’s disease, is a disorder that occurs when the adrenal glands don’t make enough of certain hormones. Adrenal insufficiency can be managed by taking hydrocortisone 20-30mg/day BID+fludrocortisone acetate 0.05 – 0.2mg/day. Cushing syndrome occurs when body is exposed to high levels of the hormone cortisol for a long time. Lung maturation in the fetus is regulated by the fetal secretion of cortisol. Respiratory distress syndrome has also been shed light upon.
Rheumatic disorders can be treated by giving oral prednisone 10 mg/kg/day and intraarticular injection: triamcinolone acetonide. Administration of prednisone: 1-2 mg/kg x 6 weeks can cure nephrotic syndrome. In allergic disease, onset of action of glucocorticoid is delayed. Bronchial asthma is a medical condition which causes the airway path of the lungs to swell and narrow. For treatment of bronchial asthma, IV methylprednisolone 60-120mg is given initially.
Antagonists of adrenocortical agents comprises receptor antagonists and synthesis inhibitors. Synthetic inhibitors and glucocorticoid antagonists constitute metyrapone which inhibits 11-hydroxylation interfering with cortisol and corticosterone synthesis. Aminoglutethimide 250mg after every 6 hours is used in breast cancer and Cushing’s syndrome and enhances metabolism of dexamethasone. Ketoconazole is a potent, non-selective inhibitor of adrenal and gonadal steroid synthesis. Activity of mifepristone and trilostane is also highlighted.
Spironolactone is used to treat certain patients with hyperaldosteronism. Mineralocorticoid antagonists eplerenone is used in clinical trials. Drospirenone is a progestin in a new oral contraceptive which antagonizes the effect of aldosterone. Primary hyperaldosteronism is due to an adrenal adenoma. Secondary hyperaldosteronism occurs due to low plasma renin, angiotensin II. Common side effects of topical corticosteroids are slowed healing, telangiectasia, purpura, rosacea, perioral dermatitis, hyper-trichosis.