Corticosteroids mineral

It is a purely synthetic steroid which essentially exerts its action as a competitive antagonist of the potent, endogeneous mineral-corticosteroid, aldosterone. Its natriuretic action seems to be slightly more particularly in the long-term therapy. In other words, it reverses these electrolyte changes by blocking the renal tubular action of the hormone. Importantly, by critically inhibiting Na reabsorption spironolactone produces diuresis and simultaneously minimises the excretion. 

The client diagnosed with Addison s disease asks the nurse, Why do I have to take fludrocortisone (Florinef), a mineral corticosteroid Which statement is the nurse s... 

Mineral corticosteroids help the body to maintain the correct serum sodium levels. Florinef is the preferred medication for Addison s disease, primary hypoaldosteronism, and congenital adrenal hyperplasia when sodium wasting occurs. 

Systemic adverse effects are dose-dependent and are rare at low to medium doses however, high-dose inhaled corticosteroids have been associated with adrenal suppression, decreased bone mineral density, skin thinning, and easy bruising.3,29 Growth suppression in children may occur even with low-dose inhaled corticosteroids however, suppression appears to occur primarily in the first year of treatment and may be due to delayed growth with the potential of future catch-up growth.30... 

One chronic adverse effect that is of concern is osteoporosis.32,33 Carbamazepine, phenytoin, phenobarbital, oxcarbazepine, and valproate have all been shown to decrease bone mineral density, even after only 6 months of treatment. Data on the relationship between other AEDs and osteoporosis are not currently available. Multiple studies have shown the risk of osteoporosis due to chronic AED use to be similar to the risk with chronic use of corticosteroids. Patients taking carbamazepine, phenytoin, phenobarbital, or valproate for longer than 6 months should take supplemental calcium and vitamin D. Additionally routine monitoring for osteoporosis should be performed every 2 years, and patients should be instructed on ways to protect themselves from fractures. 

Factors that can predispose patients to developing metabolic bone disease include deficiencies of phosphorus, calcium, and vitamin D vitamin D and/or aluminum toxicity amino acids and hypertonic dextrose infusions chronic metabolic acidosis corticosteroid therapy and lack of mobility.35,39 Calcium deficiency (due to decreased intake or increased urinary excretion) is one of the major causes of metabolic bone disease in patients receiving PN. Provide adequate calcium and phosphate with PN to improve bone mineralization and help to prevent metabolic bone disease. Administration of amino acids and chronic metabolic acidosis also appear to play an important role. Provide adequate amounts of acetate in PN admixtures to maintain acid-base balance. 

Wong CA, Walsh LJ, Smith CJ et al. Inhaled corticosteroid use and bone-mineral density in patients with asthma. Lancet 2000 355 1399-1403. 53... 

Osteoporosis is a metabolic bone disease characterized by low bone mass and micro-architectural deterioration of bone tissue. This will lead to bone fragility and consequent increase in bone fracture risk. Mean bone mineral density (BMD) is measured with dual X-ray absorptiometry (DEXA) and expressed in Tsc (Tscore). WHO standards are a Tsc that is 1 standard deviation (SD) below mean BMD is graded as normal bone, Tsc between 1 and 1.5 SD below mean BMD is graded as osteopenia and a Tsc of more than 2.5 SD below mean BMD is graded as osteoporosis. When the Tsc is below 1.5 SD mean BMD prevention of osteoporosis must be initiated. Primary osteoporosis is caused mainly by hormone deflciency in both women and men. Secondary osteoporosis may result from endocrine, metabolic, nutritional and autoimmune causes or from immobility because of trauma. Also the use of medicaments such as corticosteroids may be contributing. 

R, Bjermer L. Use of inhaled corticosteroids and bone mineral density in a population based study the Nord-Trondelag Health Study (the HUNT Study). 

Selby PL, Halsey JP, Adams KR, Klimiuk P, Knight SM, Pal B, Stewart IM, Swinson DR. Corticosteroids do not alter the threshold for vertebral fracture. J Bone Miner Res 2000 15(5) 952-6. 

Lespessailles E, Siroux V, Poupon S, Andriambelosoa N, Pothuaud L, Harba R, Benhamou CL. Long-term corticosteroid therapy induces mild changes in trabecular bone texture. J Bone Miner Res 2000 15(4) 747-53. 

Harris M, Hauser S, Nguyen TV, Kelly PJ, Rodda C, Morton J, Freezer N, Strauss BJ, Eisman JA, Walker JL. Bone mineral density in prepubertal asthmatics receiving corticosteroid treatment. J Paediatr Child Health 2001 37(1) 67-71. 

Garton MJ, Reid DM. Bone mineral density of the hip and of the anteroposterior and lateral dimensions of the spine in men with rheumatoid arthritis. Effects of low-dose corticosteroids. Arthritis Rheum 1993 36(2) 222-8. 

Buckley LM, Leib ES, Cartularo KS, Vacek PM, Cooper SM. Effects of low dose corticosteroids on the bone mineral density of patients with rheumatoid arthritis. J Rheumatol 1995 22(6) 1055-9. 

Tattersfield AE, Town GI, Johnell O, Picado C, Aubier M, Braillon P, Karlstrom R. Bone mineral density in subjects with mild asthma randomized to treatment with inhaled corticosteroids or non-corticosteroid treatment for two years. Thorax 2001 56(4) 272-8. 

Sambrook PN. Corticosteroid osteoporosis practical implications of recent trials. J Bone Miner Res 2000 15(9) 1645-9. 

Warady BD, Lindsley CB, Robinson FG, Lukert BP. Effects of nutritional supplementation on bone mineral status of children with rheumatic diseases receiving corticosteroid therapy. J Rheumatol 1994 21(3) 530-5. 

Richy F, Ethgen O, Bruyere O, Reginster JY. Efficacy of alphacalcidol and calcitriol in primary and corticosteroid-induced osteoporosis a meta-analysis of their effects on bone mineral density and fracture rate. Osteoporos Int 2004 15 301-10. 

Pitt P, Li F, Todd P, Webber D, Pack S, Moniz C. A double blind placebo controlled study to determine the effects of intermittent cyclical etidronate on bone mineral density in patients on long-term oral corticosteroid treatment. Thorax 1998 53(5) 351-6. 

Rizzoli R, Chevalley T, Slosman DO, Bonjour JP. Sodium monofluorophosphate increases vertebral bone mineral density in patients with corticosteroid-induced osteoporosis. Osteoporos Int 1995 5(l) 39-46. 

Fujita K, Kasayama S, Hashimoto J, Nagasaka Y, Nakano N, Morimoto Y, Barnes PJ, Miyatake A. Inhaled corticosteroids reduce bone mineral density in early postmenopausal but not premenopausal asthmatic women. J Bone Miner Res 2001 16(4) 782-7. 

Sivri A, Coplu L. Effect of the long-term use of inhaled corticosteroids on bone mineral density in asthmatic women. Respirology 2001 6(2) 131-4. 

Gregson RK, Rao R, Murrills AJ, Taylor PA, Warner JO. Effect of inhaled corticosteroids on bone mineral density in childhood asthma comparison of fluticasone propionate with beclomethasone dipropionate. Osteoporos Int 1998 8(5) 418-22. 

Bonala SB, Reddy BM, Silverman BA, Bassett CW, Rao YA, Amara S, Schneider AT. Bone mineral density in women with asthma on long-term inhaled corticosteroid therapy. Ann Allergy Asthma Immunol 2000 85(6 Pt 1) 495-500. 

Sambrook P, Birmingham J, Kempler S, Kelly P, Eberl S, Pocock N, Yeates M, Eisman J. Corticosteroid effects on proximal femur bone loss. J Bone Miner Res 1990 5(12) 1211-6. 

Thus, in patients with Addison s disease or other forms of adrenal insufficiency, continuing oral administration of cortisone acetate or fludrocortisone acetate enables salt balance to be restored. Other corticosteriods and analogues that have been used in the hormonal control of sodium levels include aldosterone and deoxycortone acetate. Individual corticosteroids vary in the extent to which they possess the various hormonal activities so that combination therapy is usually required if, for example, mineral balances are to be maintained when corticosteroids are administered for their anti-inflammatory, antirheumatic or anti-allergic properties. 

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