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sqadia.com provides supplement to medical students in the form of medical video lectures delivered by experienced medical practitioners with the aim to improve the medical knowledge all around the world. In view of this mission, sqadia.com offers variety of medical lectures on the medical subject of pharmacology. In this lecture of adrenocortical agonists and antagonists, experienced pharmacist sheds light on the adrenocorticosteroids, how Addison’s disease and Cushing syndrome are associated with adrenocorticosteroids and some non-adrenal disease such as rheumatic disorders, ocular disease, nephrotic syndrome. Subsequently, Sidra Afzal gives important information metyrapone, aminoglutethimide, and ketoconazole as antagonists of adrenocortical agents.
The medical lecture adrenocortical agonists and antagonists initially focusses on adrenocorticosteroids in general. Adrenocorticosteroids are compounds created by the adrenal cortex that have distant metabolic effects. The adrenocorticosteroids can be divided into two major groups: the glucocorticoids, which affect intermediate carbohydrate metabolism, and the mineralocorticoids, which affect the water and electrolyte composition of the body. The mechanism of action of the steroids involves binding to a specific receptor and forming a steroid-receptor complex. The complex then translocates into the nucleus and alters gene expression, resulting in the regulation of many cellular processes. Contraindications of adrenocorticosteroids are peptic ulcer, heart disease or hypertension with CHF, psychoses, osteoporosis.
Adrenal Diseases are discussed comprehensively in the medical video lecture at the platform of sqadia.com for medical and MBBS students. Adrenal insufficiency, including Addison’s disease, is a disorder that occurs when the adrenal glands don’t make enough of certain hormones. Adrenal insufficiency can be caused by autoimmune polyendocrinopathy. Management of adrenal insufficiency can be managed by taking hydrocortisone 20-30mg/day BID + fludrocortisone acetate 0.05 – 0.2mg/day. Cushing syndrome occurs when body is exposed to high levels of the hormone cortisol for a long time. Lung maturation in the fetus is regulated by the fetal secretion of cortisol. Treatment of the mother with large doses of glucocorticoid reduces the incidence of respiratory distress syndrome in infants delivered prematurely.
For MBBS students, detailed explanation of non-adrenal diseases is delivered under the lecture title adrenocortical agonists and antagonists. Rheumatic disorders can be treated by giving oral prednisone 10 mg/kg/day and intraarticular injection: triamcinolone acetonide. Administration of prednisone: 1-2 mg/kg x 6 weeks can cure nephrotic syndrome. In allergic disease, onset of action of glucocorticoid is delayed. Bronchial asthma is a medical condition which causes the airway path of the lungs to swell and narrow. Due to this swelling, the air path produces excess mucus making it hard to breathe. For treatment of bronchial asthma, IV methylprednisolone 60-120mg is given initially. Inhaled steroids reduce bronchial hyperreactivity with less suppression of adrenal function. Ocular disease can be treated by taking 0.1% dexamethasone.
The section adrenocortical antagonists is the demonstration of medical video lecture i.e. adrenocortical agonists and antagonists. Antagonists of adrenocortical agents comprises receptor antagonists and synthesis inhibitors. Synthetic inhibitors and glucocorticoid antagonists constitute metyrapone which inhibits 11-hydroxylation interfering with cortisol and corticosterone synthesis. Aminoglutethimide 250mg after every 6 hours is used in breast cancer and Cushing’s syndrome and enhances metabolism of dexamethasone. Ketoconazole is a potent, non-selective inhibitor of adrenal and gonadal steroid synthesis. Mifepristone has strong anti-progestin activity and blocks glucocorticoid receptor. Trilostane interferes with synthesis of adrenal and gonadal hormones.
Spironolactone is used to treat certain patients with hyperaldosteronism. Spironolactone is taken as 400-500mg/day for 5-8 weeks. Mineralocorticoid antagonists eplerenone is used in clinical trials. Drospirenone is a progestin in a new oral contraceptive which antagonizes the effect of aldosterone. Primary hyperaldosteronism is due to an adrenal adenoma. Secondary hyperaldosteronism occurs due to low plasma renin, angiotensin II. Topical corticosteroids are classified as very potent, potent, moderately, potent, and mildly potent. Common side effects of topical corticosteroids are slowed healing, telangiectasia, purpura, rosacea, perioral dermatitis, hyper-trichosis.