Glucocorticoids are necessary for life, physiological effects on the human body in many ways. Super physical quantity of glucocorticoid with anti-infection, anti-allergy and inhibits the immune response and other pharmacological effects, is often used in treatment of various types should be shock response, autoimmune diseases and inflammation. Its clinical application is very extensive, but the inappropriate use or long-term high doses can cause a variety of adverse reactions and complications, even life-threatening. This article known side effects of glucocorticoids makes a summary.
1 common adverse long-term
1.1 Cushing's syndrome can cause super-physiological dose of water, salt, sugar, protein and fat metabolism, manifested as central obesity (commonly known as moon face, buffalo back), acne, hirsutism, weakness, hypokalemia, edema, hypertension, diabetes and so on. generally do not need special treatment, can go away after stopping, if necessary, symptomatic treatment. who have high blood pressure, arteriosclerosis, heart renal insufficiency should be used with caution in patients with glucocorticoid. on the same application of cardiac glycosides and diuretics, patients should pay attention to add potassium.
1.2 induced or exacerbated by the infection of glucocorticoid anti-inflammatory effects, and its main mechanism of inhibition inflammation-promoting factor; inhibited antigen-antibody reaction; reduce capillary permeability and reduce the toxins on the body damage, so as to reduce the symptoms of inflammation. But no antibacterial hormone, and inhibition of antibody formation, interfere with humoral and cellular immune function, so that the infection proliferation. Because glucocorticoids have a strong anti-bacterial endotoxin, can reduce the heat caused by the release of endogenous and inhibit the hypothalamic response to the induced heat, a better cooling effect. In clinical practice, people often eager to find effective, the hormone as a 4 cases were . Therefore, the general application of infectious disease indications hormone treatment must be strictly controlled, and the dose should be small, treatment should be short; only bacterial infections in critically severe sepsis may occur short-term high dose of hormones, and the application must be effective enough anti-infectives. pathogen of unknown bacterial infection, resistance to bacterial, fungal and viral infections should be hanged.
1.4 induce or aggravate ulcers, bleeding, perforation of glucocorticoids can promote the secretion of gastric acid and pepsin, reduce gastric mucus secretion, to enhance protein catabolism and inhibition of protein synthesis, the gastric mucosal protection and restoration of lost capacity, it can induce or exacerbate ulcer disease, and even cause bleeding, the risk of perforation. To prevent this reaction can be added in the acid drugs. < br> 1.8 skin lesions on the hormone most sensitive facial skin, often with dark spots, wrinkles, telangiectasia, hirsutism, acne, erythema reaction, hormone-dependent dermatitis.
1.9 increased risk of cardiovascular disease, according to the heart of , cataract, eye irritation and corneal thickening pigment epithelium, corneal wound healing slows down, etc..
2 rare or rare allergic reactions adverse reactions
2.1 high dose intravenous steroid rapid systemic allergic reactions may occur, including face , nasal mucosa, eyelid swelling, hives, shortness of breath, chest tightness, asthma and even anaphylactic shock.
2.2 angina pectoris due to the mechanism of hormone may be due to quick access to the body caused by hormones norepinephrine and excessive secretion of adrenaline, excitement, a receptor, leading to vasoconstriction, coronary resistance increased, the occurrence of myocardial ischemia.
2.3 Acute hormone secreted by the pancreas and pancreatic juice can increase the viscosity, resulting in micro-duct obstruction, pancreatic bubble to expand and overflow trypsin, while hormones can lead to hyperlipidemia, and systemic infection caused by factors such as pancreatitis.
2.4 myopathy steroid hormones can cause a lot of protein catabolism with hyperthyroidism, muscle atrophy and fibrosis, muscular symmetry appears tension is low, mainly the severe lower limb proximal muscle involvement, is difficult to stand up and be characterized by squatting.
2.5 avascular necrosis of the long-term use of hormones cause fatty liver and hyperlipidemia, from the neutral fat emboli and easy adhesion to the vessel wall, blocking the terminal arteries under the cartilage, so that blood clots caused by aseptic necrosis of femoral head. if it is found that aseptic necrosis of femoral head should be discontinued or with calcium, vitamins, etc. treatment. ineffective conservative treatment may also consider surgery.
2.6 pulmonary embolism hormones inhibit fibrinolysis and to make red blood cells, platelets and thus increase the role of coagulation factors increase. Therefore, long-term use of hormones in the treatment of shortness of breath in the event of a , hemoptysis, or shock, should be highly vigilant against the occurrence of pulmonary embolism.
2.7 hemobilia long-term use of hormones can trigger atherosclerosis, the swelling and intimal proliferation, epithelial cell lipid calm, elastic tissue disease and breakage of fragile blood vessels necrotizing vasculitis. Therefore, long-term use of hormones who, once the right upper extremity pain, jaundice and melena, should be alert to the possibility of hemobilia.
2.8 renal calcification and kidney stone mild inhibition of glucocorticoid osteoporosis, reduce renal calcium and phosphorus resorption and increase their excretion effect. long-term use of glucocorticoids can calcium, phosphorus discharge increases, the high uric acid urine disease.
2.9 by glucocorticoid pharmacological dose of human placenta glucocorticoids increase placental insufficiency, decreased birth weight or the incidence of stillbirth.
2.10 glucocorticoid excretion in breast milk may be physiological and pharmacological doses or low dose (25mg daily cortisone or prednisone 5mg) no adverse effect on a baby, but as wet nurse to accept high-dose corticosteroids should not breast-feeding.
3 stops, withdrawal adverse reactions caused by adrenal cortical atrophy
3.1 or dysfunction can be prolonged glucocorticoid the endogenous glucocorticoid secretion decreased, and even lead to adrenal atrophy. sudden withdrawal or discontinuation 1 to 2 years, under certain conditions (such as major surgery, trauma, bleeding, serious infections, etc.) with acute adrenal insufficiency symptoms such as dizziness, weakness, nausea, vomiting, hypoglycemia, low blood pressure, or even coma or shock. To prevent the occurrence of this phenomenon should be a few months or more after stopping a long time to experience the stress situation timely supply sufficient hormone or ACTH, or after withdrawal of testosterone propionate treatment given to reduce the chance occurrence of the event, according adrenal crisis rescue.
3.2 rebound phenomenon of long-term use of glucocorticoid drugs, the symptoms completely control, mitigation, but a sudden stop or reduce excessive too fast, showing that the phenomenon of primary disease recurrence or worsening of the phenomenon known as rebound. more dependence by the patient on the hormones, caused by a sudden drop in hormone levels. At this time can be further use of hormones. To avoid this, patients over 1 week of hormone reduction should be slow, and even withdrawal.
3.3 disable syndrome refers to a sudden stop after the withdrawal does not have some of the original clinical syndrome, such as muscle pain, joint pain, muscle stiffness, fatigue, weakness, fever, depression, or no desire status, few patients can be caused by collapse, as the hypothalamus - pituitary - adrenal axis due to temporary dysfunction. At this point in time to restore the original type and dose of corticosteroids , to be followed by a gradual reduction of symptoms of a smooth, gradual withdrawal.
there may be many side effects of hormones are not we find and grasp. hormones and other drugs, the interaction between the very extensive. clinical use should be strictly controlled to adapt to hormone card, use the drug, dosage and prevention of adverse reactions.
【Reference】
1 YAO Tai. physiology. Beijing: People Health Press ,2005,593-595.
2 Shi-Jie Yang . pharmacology. Beijing: People Health Press ,2005,121-129.
3 Zhuangfu Guo, Meng Qingcheng. infectious diseases lethal abuse of glucocorticoid report of 4 cases. Journal of Practical Medicine, 2003,3 (6): 557.
4 Liu North Sea, Liu. ophthalmology glucocorticoid induced severe mental disorders analysis. Journal of Modern Journal of Ophthalmology, 2005,1 (1): 81.
5 Haiying, Li Yuzhen. glucocorticoids pharmacological properties of drugs and rational use. Clinical Drug Therapy, 2004,2 (3): 36.
6 Train of Hebi Xiu. glucocorticoid-induced insulin resistance in the molecular principles. of Chinese Physician, 2001,3 (9) :656-658.
No comments:
Post a Comment