McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 3 6 Adrenocortical agents

Hypothalamus

CRH

Budesonide, dexamethasone and hydrocortisone work here, ophthalmic

Beclomethasone, budenoside, dexamethasone and flunisolide work here, inhaled Dexamethasone, hydrocortisone and prednisolone work here, intra-articular

Cortex

Anterior pituitary

ACTH

Betamethasone, cortisone, dexamethasone, hydrocortisone, methylpredinsolone, prednisolone, prednisone and triamcinolone work systematically

Mineralocorticoids

Betamethasone, dexamethasone, hydrocortisone and predisone work here, topical

Adrenal gland

Medulla

Androgens similar to male/female sex hormones stimulation Glucocorticoids betamethasone, budesonides

dexamethasone, hydrocortisone, methylprednisolone, prednisolone, prednisone and triamcinolone: glucose formation, protein breakdown, fat deposit, immune suppression

Fludrocortisone, cortisone and hydrocortisone act here

Kidney

Na + water retention K + excretion

FIGURE 36.2  Sites of action of the adrenocortical agents.

TABLE 36.3

DRUGS IN FOCUS Adrenocortical agents

Drug name

Dosage/route

Usual indications

Glucocorticoids beclomethasone (Beconase, Qvar)

Nasal spray, respiratory inhalant Adult: two inhalations (84–168 mcg) t.d.s. to q.i.d. for respiratory inhalant; one inhalation (42–84 mcg) in each nostril b.d. to q.i.d. for nasal spray Paediatric (6–12 years): one or two inhalations t.d.s. to q.i.d. for respiratory inhalant Paediatric (>12 years): one inhalation in each nostril b.d. to q.i.d. for nasal spray Oral, IM, IV, intra-articular, topical Adult: 0.6–7.2 mg/day PO; up to 9 mg/day IV; 0.5–9.0 mg/day IM; apply topical preparation sparingly Paediatric: individualise dose based on severity and response, and monitor closely Intranasal: adults and children >6 years: 256 mcg/day given as two sprays in each nostril a.m. and p.m.

Blocking inflammation in the respiratory tract

betamethasone (Celestone, Diprosone)

Management of allergic intra-articular, topical and inflammatory disorders

budesonide (Rhinocort, Entocort, Pulmicort, Rhinocort, Symbicort)

Relief of symptoms of seasonal and allergic rhinitis with few side effects; approved in 2001 as an oral agent for the treatment of mild-to-moderate active Crohn’s disease Continued on following page