C H A P T E R 3 6
Adrenocortical agents
541
Hypothalamus
CRH
ACTH
Adrenal
gland
Cortex
Na
+
water retention
K
+
excretion
Medulla
Mineralocorticoids
Budesonide, dexamethasone
and hydrocortisone work
here, ophthalmic
Beclomethasone,
budenoside,
dexamethasone
and flunisolide work here,
inhaled
Dexamethasone,
hydrocortisone and
prednisolone work here,
intra-articular
Betamethasone,
dexamethasone,
hydrocortisone and
predisone work here,
topical
Betamethasone,
cortisone,
dexamethasone,
hydrocortisone,
methylpredinsolone,
prednisolone,
prednisone and
triamcinolone
work systematically
Fludrocortisone, cortisone and
hydrocortisone act here
Kidney
Anterior
pituitary
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
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
Blocking inflammation in the respiratory
tract
betamethasone
(Celestone, Diprosone)
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
Management of allergic intra-articular,
topical and inflammatory disorders
budesonide (Rhinocort,
Entocort, Pulmicort,
Rhinocort, Symbicort)
Intranasal: adults and children >6 years:
256 mcg/day given as two sprays in each
nostril a.m. and p.m.
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
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