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INTRODUCTION
1.
Cs
hormone
That effects almost every organ/systems S.E . . . . . . . (1)
2. Therapeutic uses
* endocrine * non endocrine substitution th/.
AI & IMMUNOSUPPRESIVE
masking effect
Adrenal cortex
Glucocorticoids
CS (CORTISOL)
* antiinflammatory immunosuppressive * metabolic potency MINERALOCORTICOIDS (Aldosteron) * Sod water retention edema BT androgen
REGULATION
Synthesis & secretion
What happens to the patient who chrocicaly consum CS exogen in large dosage ?
CS level
FBH (-)
DIURNAL CYCLE
Concentrion in plasma 8 am : 16 mg/100 ml 4 pm : 4 mg/100 ml What does this clinically mean ?
CORTISOL
Natural glucocorticoid
PHARMACOKINETICS
A : CS is a lipophylic drug * Good : intestinal (p.o) Conjunctival space (topical) Synovial (p.e) Nasal (spray) * Slowly : skin Good penetration : mucosa, conjunctiva, sirotum - face
E : Kidney
MECHANISM OF ACTION
1. AFFECTS THE RNA TRANSCRIPTION RNA
CS EFFECTS
I. METABOLIC EFFECTS
Cs dose related effect on CM, protein and fat metabolism 1. Carbohydrate gluconeogenesis HYPERGLYCAEMIA or GLUCOCA 2. Proteins Catabolic effect in lymphoid connective tissue muscle ATROPHY fat skin
3. Fat
Redistribution of fat
atrophy
2. On cellular events Indication * in area of acute inflammation : decreased ( ) number and activity of leucosit
* in area of chronic inflammation : decreased activity of mononuclear cells. Decreased fibroblast function * in lymphoid areas : decreased clonal expansion of T and B cells. decreased action of cytokine secreting T cells.
3. On inflammatory and immune mediators decreased : cytokines (IL) eicosanoid PAF complement histamin 4. Histamin release from basophil
(2) (3) INDICATION : ALLERGIC AUTOIMMUNE DISEASE TRANSPLANTION LLA ADR : IMMUNOSUPRESSIV poor wound healing, vurnable to infection
III. BONE
Long term CS treatment OSTEOPOROSIS High risk : children post menopausal IV. CNS euphoria treatment
V. STOMATCH
VI. ELECTROLYTE AND WATER BALANCE Retention : sodium & water edema BPT
IX. GROWTH
growth retardation
X. REPRODUCTIVE synthesis & secretion of gonadotropins : hypogonadism : anovulation, oligomenorrhea, uterine bleeding
ADVERSE EFFECT
I. LARGE DOSE LONG TERM CS THERAPI
>= 7 days
Abrupt stopped
Reactivation (exacerbation) of the disease Anorexia, nausea, vomiting, weigh loss,
lethargy, headache, fever, joint-muscle pain, postural hipotension Tapering off or alternate day
CS SYNTHESIS
Compound Anti Inflammatory Potency 1 0,8 4 4 5 5 25 25 Na+ retaining Metabolic DOA Pot Pot Equivalent Dose
20 5 5 4 1 1-1,5
S S I I I I L L
20 5 5 4 4 0,75 0,6
S : 8-12 h
I : 12-36 h
L : 36-72 h
SELECTION OF DRUG
1. REPLACEMENT THERAPY 2. LONG TERM ANTIINFLAMMATORY
3. THERAPY ACUTELY
DEXAMETHASONE
Synthetic CS
AI T (20)
Na water retaining potency 0 Metabolic potency (0)
KORTIKOSTEROID TOPIKAL
Untuk kelainan kulit. Klasifikasi KS Topikal
Golongan 1 Potensi Sangat Lemah Nama KST Hidrokortison m-prednisolon Deksametason Aklometason dipropionat Betametason valerat Triamsinolon asetonid Hidrokortison butirat Flutikason propionat Desoksimetason Flusinolon asetonid Hidrokortison valerat Mometason fluroat Flusinolon asetonid Bentuk krim 0,25 2,5% krim 0,25 & 1,0% krim 0,1% krim 0,05% krim 0,01% krim 0,025% krim 0,1% krim 0,05% krim 0,05% krim 0,25% krim 0,2% krim 0,1% salep 0,02%
Lemah
Sedang
Kuat/poten
krim 0,05% salep 0,005% salep 0,2% krim 0,05% salep 0,1% dalam vehikulum yang dioptimalkan 0,05% krim 0,05% krim 0,05%
Sangat poten
EFEK KS TOPIKAL
1. Vasokontraksi vasokontriksi kapiler-kapiler di lap. dermis superficial eritema berkurang (pada : sunburn) 2. Antiproliferasi mengurangi mitosis dan proliferasi (pada : Psoriasis)
ABSORPSI (PENETRASI)
* Pada kulit normal hanya sedikit diabsorpsi, pada kulit terinflomasi absorpsi meningkat.
PEMILIHAN KS
1. KS lemah regio : skrotum, kelopak mata bayi kelainan luas kelainan kulit responsit Penggunaan : 4 6 minggu
INDICATION
1. Allergic drug reaction 2. Allergic rhinitis 3. Atopic dermatitis, exzema 4. Rheumatoid arthritis 5. Bronchial asthma 6. LLA 7. Organ transplants 8. Cerebral deem 9. Septicemia 10. Nephritic syndrome 11. Lupus erythematic