Glucocorticoids specific drugs

Glucocorticoids induce cataract formation, particularly in patients with rheumatoid arthritis. An increase in intraocular pressure related to a decreased outflow of aqueous humor is also a frequent side effect of periocular, topical, or systemic administration. Induction of ocular hypertension, which occurs in about 35% of the general population after glucocorticoid administration, depends on the specific drug, the dose, the frequency of administration, and the glucocorticoid responsiveness of the patient. 

Inhaled glucocorticoids are therefore the cornerstone of drug therapy for patients with asthma. Leukotriene inhibitors, beta agonists, and theophylline can be used to supplement glucocorticoids as needed, with the specific drug regimen determined on... 

A second example is the colon-specific delivery of glucocorticoids linked to dextran via a succinic acid or glutaric acid spacer [256a]. Such conjugates resist hydrolysis in the upper gastrointestinal tract, but are rapidly degraded by bacteria in the colon and caecum where little drug absorption occurs. 

Evidence also suggests that leukotriene inhibitors can be combined with other drugs (glucocorticoids, beta agonists) to provide optimal management in specific patients with asthma and COPD.11,60 In particular, it appears that these drugs may enhance the anti-inflammatory effects of glucocorticoids, and may therefore provide therapeutic effects at a relatively... 

General Indication Allergic disorders Principal Desired of Glucocorticoids Decreased inflammation Examples of Specific Disorders Anaphylactic reactions, drug-induced allergic reactions, severe hay fever, serum sickness... 

Mechanism of Action. Cyclosporine and tacrolimus (see below) are known as calcineurin inhibitors because they inhibit a specific protein (calcineurin) in lymphoid tissues. This inhibition ultimately suppresses the production of IL-2, a cytokine that plays a critical role in immune response by promoting the growth and proliferation of activated T lymphocytes and other immune cells, such as NK. cells (see Fig. 37—1).5,52 Thus, cyclosporine is one of the premier immunosuppressants because of its relative selectivity for T cells and its inhibition of a key mediator of the immune response (IL-2).41 This relatively specific inhibition is often advantageous when compared with other nonse-lective drugs such as azathioprine, cyclophosphamide, and glucocorticoids that inhibit virtually all the cells and chemical mediators involved in the immune response. 

Mineralocorticoids act by binding to the mineralocorticoid receptor in the cytoplasm of target cells, especially principal cells of the distal convoluted and collecting tubules of the kidney. The drug-receptor complex activates a series of events similar to those described above for the glucocorticoids and illustrated in Figure 39-3. It is of interest that this receptor has the same affinity for cortisol, which is present in much higher concentrations in the extracellular fluid. The specificity for mineralocorticoids at this site appears to be conferred, at least in part, by the presence of the... 

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