Penetration differs at different sites:
High: axilla, groin, face, scalp, scrotum
Medium: limbs, trunk
Low: palm, sole, elbow, knee
Occlusive dressing enhance absorption (10 fold)
Absorption is greater in infants & Children
Absorption depends on nature of lesion:
High: atopic & exfoliative dermatitis
Low: hyperkeratinized & plaque forming lesions
More than 3 applications a day is not needed
Choice of vehicle is important
Lotions & creams: for exudative lesions
Sprays & gels: for hairy regions
Ointments: for chronic scaly lesions
(By Dr. Ahmad Najmi, Index Medical College, Indore)
Monday, June 7, 2010
Sunday, June 6, 2010
Therapeutic uses of corticosteroids
(By Dr. Ahmad Najmi, Index Medical College, Indore)
1. Endocrine Disorders
Acute adrenal insufficiency
Primary adrenocortical insufficiency
Ad. Insufficiency second. to Ant. Pituitary
Congenital adrenal hyperplasia
2. Rheumatic carditis
Not responding to salicylates
Severely ill pts.
Prednisolone 40mg in divided doses
Salicylates given concurrently to prevent reactivation
3. Arthritis
Not the drug of first choice
Prednisolone 5 or 7.5 mg
Intra-articular injection
4. Renal diseases (Nephrotic syndrome)
Prednisolone 60 mg in divided doses for 3 – 4 weeks
If remission occurs continue for 1 year
Do not modify the course of disease; Some may benefit
5. Collagen diseases
DLE, pemphigus vulgaris, polyarteritis nodosa
Defect in connective tissue proteins in joints, various organs and deeper layer of skin
6. Allergic diseases
Anaphylactic shock, blood transfusion reaction, hay fever
Prednisolone (short course)
7. Bronchial asthma
Not routinely used except in Status asthmaticus
Methyl prednisolone sodium i.v. given followed by oral prednisolone
Inhaled steroids (Minimal HPA axis suppression
8. Ocular diseases
Outer eye & anterior segment: local application
Posterior segment: systemic use
Caution: bacterial, viral & fungal conjunctivitis
9. Dermatological conditions
Pempigus: Life saving therapy is steroids
Eczema, dermatitis & psoriasis: respond well
10. . Diseases of intestinal Tract
Ulcerative colitis: cortisol retention enema
11. Cerebral oedema
Questionable value in cerebral oedema following trauma, cerebrovascular oedema
Valuable in oedema associated with neoplasm and parasites
13. Malignancy
Part of multi drug regimens for acute lymphatic leukaemia (children), chronic lymphatic leukaemia (adult)
Prednisolone 1mg/Kg start; gradually reduce the dose
1. Endocrine Disorders
Acute adrenal insufficiency
Primary adrenocortical insufficiency
Ad. Insufficiency second. to Ant. Pituitary
Congenital adrenal hyperplasia
2. Rheumatic carditis
Not responding to salicylates
Severely ill pts.
Prednisolone 40mg in divided doses
Salicylates given concurrently to prevent reactivation
3. Arthritis
Not the drug of first choice
Prednisolone 5 or 7.5 mg
Intra-articular injection
4. Renal diseases (Nephrotic syndrome)
Prednisolone 60 mg in divided doses for 3 – 4 weeks
If remission occurs continue for 1 year
Do not modify the course of disease; Some may benefit
5. Collagen diseases
DLE, pemphigus vulgaris, polyarteritis nodosa
Defect in connective tissue proteins in joints, various organs and deeper layer of skin
6. Allergic diseases
Anaphylactic shock, blood transfusion reaction, hay fever
Prednisolone (short course)
7. Bronchial asthma
Not routinely used except in Status asthmaticus
Methyl prednisolone sodium i.v. given followed by oral prednisolone
Inhaled steroids (Minimal HPA axis suppression
8. Ocular diseases
Outer eye & anterior segment: local application
Posterior segment: systemic use
Caution: bacterial, viral & fungal conjunctivitis
9. Dermatological conditions
Pempigus: Life saving therapy is steroids
Eczema, dermatitis & psoriasis: respond well
10. . Diseases of intestinal Tract
Ulcerative colitis: cortisol retention enema
11. Cerebral oedema
Questionable value in cerebral oedema following trauma, cerebrovascular oedema
Valuable in oedema associated with neoplasm and parasites
13. Malignancy
Part of multi drug regimens for acute lymphatic leukaemia (children), chronic lymphatic leukaemia (adult)
Prednisolone 1mg/Kg start; gradually reduce the dose
Saturday, June 5, 2010
Contraindications of corticosteroids
Infections
Hypertension with CCF
Psychosis
Peptic ulcer
Diabetes mellitus
Osteoporosis
Glaucoma
Pregnancy : (prednisolone preferred)
Hypertension with CCF
Psychosis
Peptic ulcer
Diabetes mellitus
Osteoporosis
Glaucoma
Pregnancy : (prednisolone preferred)
Adverse effects of corticosteroids
Iatrogenic Cushing’s syndrome
Hyperglycaemia, glycosuria, diabetes
Myopathy (negative nitrogen balance)
Osteoporosis (vertebral compression fracture)
Retardation of growth (children)
Hypertension, oedema,CCF
Avascular necrosis of femur
HPA axis suppression
Behavioral toxicity: Euphoria, psychomotor reactions, suicidal tendency
Ocular toxicity: steroid induced glaucoma,posterior subcapsular cataract.
Others:
Superinfections
Delayed wound healing
Steroid arthropathy
Peptic ulcer
Live vaccines are dangerous
By Dr. Ahmad Najmi, Index Medical College, Indore
Hyperglycaemia, glycosuria, diabetes
Myopathy (negative nitrogen balance)
Osteoporosis (vertebral compression fracture)
Retardation of growth (children)
Hypertension, oedema,CCF
Avascular necrosis of femur
HPA axis suppression
Behavioral toxicity: Euphoria, psychomotor reactions, suicidal tendency
Ocular toxicity: steroid induced glaucoma,posterior subcapsular cataract.
Others:
Superinfections
Delayed wound healing
Steroid arthropathy
Peptic ulcer
Live vaccines are dangerous
By Dr. Ahmad Najmi, Index Medical College, Indore
Finasteride
5-alpha reductase inhibitor
Orally active
used in BPH
Dose 5 mg/day
Decrease prostate volume
Decrease symptom score
Decrease DHT level in prostate
Also used for androgenic alopecia
ADR: loss of libido & impotense in 5 % patients
Orally active
used in BPH
Dose 5 mg/day
Decrease prostate volume
Decrease symptom score
Decrease DHT level in prostate
Also used for androgenic alopecia
ADR: loss of libido & impotense in 5 % patients
Define briefly drug antagonism ?
(By Dr. Ahmad Najmi, Index Medical College, Indore)
When one drug decrease the action of another drug, they are k/a antagonist.Depending on mechanism involved antagonism may be
1. Physical e.g. charcoal adsorb alkaloids
2. Chemical e.g. Chelating agents complex toxic metals
3. Physiological e.g. Glucagon & insulin on blood sugar
4. Receptor is further divided into competetive & noncompetetive
In competetive type of antagonism, antagonist is chemically similar to agonist & bind to the same site.
In noncompetetive type of antagonism, the antagonist is chemically unrelated to the agonist, bind to a different allosteric site.
When one drug decrease the action of another drug, they are k/a antagonist.Depending on mechanism involved antagonism may be
1. Physical e.g. charcoal adsorb alkaloids
2. Chemical e.g. Chelating agents complex toxic metals
3. Physiological e.g. Glucagon & insulin on blood sugar
4. Receptor is further divided into competetive & noncompetetive
In competetive type of antagonism, antagonist is chemically similar to agonist & bind to the same site.
In noncompetetive type of antagonism, the antagonist is chemically unrelated to the agonist, bind to a different allosteric site.
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