Glucocorticoids in Pharmacology – Adrenal Insufficiency

00:01 Let’s do glucocorticoid in pharmacology.

00:04 Compared with cortisol, these synthetic derivatives have better oral availability, longer half-life, less mineralocorticoid activity... compared with cortisol.

00:13 We’re talking about synthetic derivatives of cortisol.

00:16 Examples: hydrocortisone, prednisone, prednisolone and betamethasone.

00:22 These drugs you should be extremely familiar with, these are synthetic pharmacologic glucocorticoids.

00:27 Adverse effects, we talked about iatrogenic Cushing’s.

00:30 Why in the world are we talking about Cushing’s here? Only because on the outside, the patient looks like a typical Cushing’s patient; on the inside, what is actually happening? The adrenals are undergoing atrophy.

00:45 Remember secondary adrenal insufficiency.

00:47 The adrenals are atrophic.

00:50 What else is happening when you give glucocorticoid? This is a nice little summary of adverse effects.

00:55 Suppression of skeletal growth in children, decreased wound healing, suppression of immune system, varied central nervous system effects.

01:04 The suppression of ACTH, in fact, once again will cause secondary adrenal insufficiency.

01:09 You will never abruptly stop this patient from taking glucocorticoid-glucocorticoid, never.

01:18 If that occurs and the patient gets into a physiologic stressful situation such as shock, the patient’s going to die of Addisonian crisis.