How to rationally use adrenal glucocorticoids
Commonly used anti-inflammatory drugs mainly include adrenal glucocorticoids and non-steroidal anti-inflammatory drugs. Here, we will mainly introduce the rational application of adrenal glucocorticoids.
- Rational application principle of adrenal glucocorticoids
(1) Reasonable drug selection The pharmacodynamics and human pharmacokinetics (absorption, distribution, metabolism and discharge process) of different glucocorticoids have different characteristics, so each has different clinical indications, which should be based on different diseases and various diseases. The characteristics of glucocorticoids are correctly selected from glucocorticoids.
(2) According to the purpose of treatment and under the guidance of a physician, various glucocorticoids can be applied to physiological dose replacement therapy, high-dose assault therapy, general dose long-term therapy and topical use, etc. Be sure to choose under the guidance of a doctor.
(3) Selecting suitable treatment for impact therapy is generally less than 5 days, suitable for rescue of critically ill patients, such as anaphylactic shock, persistent asthma, allergic laryngeal edema, lupus encephalopathy, acute nephritis, etc.; 1 month, suitable for infection or allergic diseases, such as tuberculous meningitis and pleurisy, exfoliative dermatitis or acute rejection of organ transplantation, etc., need to gradually reduce the dose to discontinuation when stopping the drug; the intermediate course is 3 months Within, it is suitable for long-term and multi-organ disease, such as rheumatic fever, reduced to maintenance dose after it is effective, need to gradually decrease when stopping the drug; long-term treatment requires more than 3 months, suitable for rejection after organ transplantation, system For lupus erythematosus, hemolytic anemia, bullous skin disease, etc., maintenance therapy can be administered daily or every other day. Before stopping the drug, it should be gradually transitioned to the next day after the therapy is gradually discontinued; lifelong replacement therapy is suitable for primary or Secondary chronic adrenal insufficiency, appropriate dose increase under stress.
(4) Monitoring adverse reactions of glucocorticoids The adverse reactions of glucocorticoids are obviously related to the variety, dosage, course of treatment, dosage form and usage of the drug. In the course of use, infections, metabolic disorders (water, electrolytes, blood sugar, blood lipids) should be closely monitored. Adverse reactions such as weight gain, bleeding tendency, abnormal blood pressure, osteoporosis, necrosis of the femoral head, and children should also monitor growth and development. In addition, it is particularly noted that many skin external preparations contain glucocorticoids, although they can exert strong anti-inflammatory, antipruritic, anti-exudation and epidermal proliferation effects, but long-term application at a fixed site can lead to skin bacteria or fungi. Adverse reactions such as infection, rosacea dermatitis or perioral dermatitis, increased hemorrhoids, skin atrophy, telangiectasia, and pigmentation.
(5) Pay attention to the drug withdrawal reaction and rebound phenomenon. It refers to the long-term use or large dose of glucocorticoids. If the reduction is too fast or suddenly stopped, adrenal insufficiency-like symptoms may occur. Asthma, fatigue, loss of appetite, joint and muscle pain, severe cases may occur fever, nausea, vomiting, hypotension, etc., critically ill even adrenal cortical crisis, need to be rescued in time. The phenomenon of rebound, refers to the long-term use of glucocorticoids, the reduction of excessive or sudden withdrawal can cause the primary disease to relapse or aggravate, should restore glucocorticoid treatment and often need to increase the dose, then slowly reduce after stabilization the amount.
- Precautions for the correct use of glucocorticoids
(1) Clearly avoid using glucocorticoids. Allergic to glucocorticoids, severe psychiatric history, epilepsy, active peptic ulcer, recent gastrointestinal anastomosis, fracture, wound repair, herpes simplex conjunctivitis And ulcerative keratitis, corneal ulcers, severe hypertension, severe diabetes, uncontrolled infections (such as varicella, fungal infections), active tuberculosis, more severe osteoporosis, early pregnancy and puerperium, psoriasis vulgaris .
(2) Understand the use of glucocorticoids in patients with Cushing’s syndrome, atherosclerosis, intestinal diseases or chronic malnutrition and patients with recent surgery; acute heart failure, diabetes, psychotic tendency, glaucoma Hyperlipoproteinemia, hypertension, myasthenia gravis, severe osteoporosis, peptic ulcer disease, pregnancy and lactation women should be used with caution; infectious diseases must be combined with effective antibiotics, and patients with viral infections should be used with caution. Children should also be used with caution.
(3) Other precautions to prevent cross-allergy, allergic to a certain glucocorticoid may also be allergic to other glucocorticoids; when using glucocorticoids, the following measures may be taken as appropriate, low sodium, high potassium, high protein diet, supplement Calcium and vitamin D, plus drugs to prevent adverse reactions such as peptic ulcer and bleeding; if there is infection, antibiotics should be used at the same time to prevent the spread and aggravation of infection; pay attention to the pharmacokinetic characteristics and disease specific conditions of different glucocorticoids Reasonable selection of glucocorticoid varieties and dosage forms.
(4) Interaction with other drugs Recently, the use of barbiturate, carbamazepine, phenytoin, primidone or rifampicin may increase metabolism and reduce the role of glucocorticoids; instead, oral contraceptives or Ritonavir can increase the blood concentration of glucocorticoids; mineralocorticoids combined with potassium-sparing diuretics can cause excessive potassium loss; glucocorticoids and non-steroidal anti-inflammatory drugs when combined, gastrointestinal bleeding and ulcers The incidence is high.