Mineralocorticoides

Estructura Química y Farmacodinamia

Estructura química

La fludrocortisona es el principal medicamento de esta clase.

• Mineralocorticoide sintético
• Análogo fluorado de cortisol Cortisol Glucocorticoids

Mecanismo de acción

• Imita el efecto de la aldosterona → actúa sobre los LOS Neisseria receptores de mineralocorticoides ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el citoplasma) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria riñones:
  • Túbulo contorneado distal
  • Conducto colector
• ↑ Transcripción de ácido desoxirribonucleico (ADN) y traducción de proteínas para canales en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum células de los LOS Neisseria túbulos renales:
  • ↑ Canales de Na⁺ (lado apical) → ↑ reabsorción de Na⁺ → reabsorción de agua
  • ↑ Na⁺/K⁺ ATPasa (lado basolateral) → ↑ excreción de K⁺ a través de los LOS Neisseria canales de potasio de la médula externa renal (lado apical)

Efectos fisiológicos

• ↑ Na⁺ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum plasma Plasma The residual portion of blood that is left after removal of blood cells by centrifugation without prior blood coagulation. Transfusion Products y retención de agua → ↑ presión arterial
• ↓ K⁺ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum plasma Plasma The residual portion of blood that is left after removal of blood cells by centrifugation without prior blood coagulation. Transfusion Products
• Además, tiene actividad y efectos glucocorticoides

Farmacocinética

Absorción

• Administrados por vía oral
• Rápida y completa

Distribución

• 70%‒80% se une a proteínas:
  • Albúmina
  • Globulina transportadora de corticosteroides
• La estructura fluorada protege de la oxidación (isoenzima 11-beta-hidroxiesteroide deshidrogenasa) y la inactivación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el riñón → permite la potencia mineralocorticoide

Metabolismo y excreción

• Metabolismo hepático
• Excreción:
  • Principalmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina
  • Minoritario en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum heces

Indicaciones

Aunque la fludrocortisona tiene actividad glucocorticoide, se usa principalmente por su actividad mineralocorticoide (particularmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum afecciones con producción inadecuada de aldosterona).

• Junto con un glucocorticoide:
  • Insuficiencia suprarrenal
  • Hiperplasia suprarrenal congénita
  • Shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock séptico que no ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia respondido a la reanimación con líquidos por vía intravenosa (uso distinto al AL Amyloidosis de la ficha técnica)
• Junto con ↑ la ingesta de sal y/o líquidos (uso distinto al AL Amyloidosis de la ficha técnica):
  • Hipotensión ortostática
  • Síndrome de taquicardia ortostática postural
  • Pérdida de sal cerebral

Efectos Secundarios y Contraindicaciones

Efectos secundarios

Hay muchos efectos secundarios de la terapia con fludrocortisona, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum particular:

• Cardiovasculares:
  • Hipertensión
  • Retención de líquidos y edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema
  • Insuficiencia cardiaca descompensada
• Alteraciones endocrinas y electrolíticas:
  • Hiperglucemia y diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus
  • Aumento de peso
  • Síndrome de Cushing
  • Supresión del crecimiento
  • Hipopotasemia
  • Alcalosis metabólica
• Sistema nervioso central (SNC):
  • Delirio
  • Psicosis
  • ↑ Presión intracraneal
  • Convulsiones
• Dermatológicos:
  • Acné
  • Hiperpigmentación
  • Estrías
  • Atrofia de la piel
  • Retraso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la cicatrización de heridas
• Musculoesqueléticos:
  • Miopatía
  • Osteonecrosis
  • Osteoporosis Osteoporosis Osteoporosis refers to a decrease in bone mass and density leading to an increased number of fractures. There are 2 forms of osteoporosis: primary, which is commonly postmenopausal or senile; and secondary, which is a manifestation of immobilization, underlying medical disorders, or long-term use of certain medications. Osteoporosis
• Gastrointestinales: úlceras
• Oftálmicos:
  • Glaucoma Glaucoma Glaucoma is an optic neuropathy characterized by typical visual field defects and optic nerve atrophy seen as optic disc cupping on examination. The acute form of glaucoma is a medical emergency. Glaucoma is often, but not always, caused by increased intraocular pressure (IOP). Glaucoma
  • Cataratas
• Abstinencia:
  • La terapia crónica da como resultado la supresión del eje hipotálamo-hipofisario-suprarrenal
  • La interrupción abrupta puede causar insuficiencia suprarrenal.

Contraindicaciones y precauciones

• Contraindicaciones:
  • Infección fúngica sistémica
  • Alergia previa a los LOS Neisseria corticosteroides (reactividad cruzada potencial)
• Utilizar con precaución en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Deterioro hepático o renal grave
  • Insuficiencia cardíaca
  • Hipertensión
  • Infarto de miocardio (IM) agudo reciente → riesgo de rotura miocárdica
  • Hiperglucemia no controlada

Interacciones medicamentosas

• ↑ Riesgo de hipopotasemia:
  • Diuréticos
  • Digoxina
  • Anfotericina B
• ↑ Riesgo de úlceras y sangrado gastrointestinal: antiinflamatorios no esteroideos (AINE)
• ↑ Retención de líquidos:
  • Andrógenos
• ↓ Absorción de fludrocortisona:
  • Inhibidores de la bomba de protones
  • Antiácidos
  • Secuestradores de ácidos biliares
• Puede ser necesario ajustar la dosis de los LOS Neisseria agentes antidiabéticos.