Hydrocortisone

Chemical name

(11бета)-11,17,21-Тригидрок сипрегн-4-ен-3,20-дион

Gross

C21-H30-O5

Characteristics

Hydrocortisone-hormone, secretiruemy napochechnikov crust. White or almost white powder odourless, it is very poorly soluble in water. Hydrocortisone acetate and hydrocortisone tsipionat (are synthetically), insoluble in water and poorly soluble in alcohol and chloroform. In contrast, hydrocortisone sodium phosphate and hydrocortisone sodium succinate (also produce synthesis), easily soluble in water, hygroscopic.

Of drugs

The drugs-противошоковое, antiinflammatory, противоаллергическое, десенсибилизирующее, иммунодепрессивное, антиэкссудативное, противозудное. Well absorbed after administration inwards. C_max achieved through 1hr After the / m of absorption slow (24-48 h). Associated with the plasma transkortinom by 70-80%, with albuminom-10%. It permeates through the mucous membranes and gistogematicalkie barriers. Intensive metabolised in the liver. Metabolites (inactive ethers - glukuronida, sulphates, are water soluble) made with urine. In platzente metabolised about 70% hydrocortisone education 11-ketoforma inactive. Following application on the skin accumulate in the epidermis. Absorbirovannaya part metabolised in the epidermis, and then, the liver. Metabolites, and the small amount of hydrocortisone presented with urine or Jelchew.tormozit gipercuvstvenosti reaction, and proliferativee ekssoudativee processes in the connective tissue in the middle of inflammation. Provides local hyperemia and gipertermiu skin. The fear through Wärmetauscher specific receptors. Prev e60 ents activation fosfolipaza A_2 by promoting its education inhibitor-lipomodulina and direct effects on membrane violates synthesis GHGs and the macrophagic hemotaksicski factor ingibiruet activation kininov fabric. Decreases migration macrophages and lymphocytes in the center of inflammation. Fc-retseptora block on the surface of macrophages for IgG and S_3 complement component. 4-3 lizosom membrane, preventing the lysosomal enzymes. Suppress alteratiou, exudation and proliferatiou. In high doses, slows development limfoidna and connective tissue, oppressing antigialuronidasy activity, reduces the permeability of capillaries. Stops kollagenaza products and activates the synthesis of protease inhibitors. Does fusion and the release of sensitised fat cells and bazofilov gistamina and other biologically active substances, wherein the different stages of immunogenesis, without causing mitozostaticski action. Increases of glycogen in the liver, slows the sodium and water, increases-potassium affect protein (a negative balance of nitrogenous by increasing katabolizma) and the London exchange. Increases BCC, hydrophily tissues increases AD. Threshold dose leading to the development of Kushinga syndrome in long-term use is about 30 mg. If long-term use is quite crust napochechnikov, oppressed ACTG education and tireotroponogo hormone Gipofiza.okazavaet expressed protivosokowoe, противовоспалительно е and protiwallergicescoe effect. Hydrocortisone acetate is developing slowly, but higher than that of water-soluble drugs effect. Used to give joints, places injuries and soft tissue, which provides local противовоспалительно е , though there is a growing systemic hormonal effects. Curative effects in a vnutrisustavne occurs within 6-24 hours, and it lasts from several days to several weeks. Injections hydrocortisone phosphate accompanied by the rapid suppression of inflammation, but for a short time, so it is preferable to use in severe conditions. Hydrocortisone sodium succinate as the metabolic, and противовоспалительно й activity. After the on / in the place is a one hour duration varies. Excretion imposed doses will be completed within 12 hours The need to maintain high plasma concentrations recommended imposition every 4-6 hours The salt hydrocortisone rapidly absorbed and in the / m introduction excreted in the same way as the on / in the application.

Indications

Seasonal allergic rhinitis, a severe attack of asthma, astmaticescoe state savorotocnaya disease response гиперчувствительност и the introduction of drugs; Urgent state-spontaneous and ortostatical gipotenzia, with the collapse of Addison disease, myocardial infarction, haemorrhagic stroke syndrome Morgagni-Adams-Stokes, coma if there is a violation of cerebral circulation and inflammatory diseases brain gipotireoidnaya and hepatic coma, the acute lack napochechnikovaya (syndrome Waterhausa - Friederiksena), multiple bleeding, acute liver failure in case of poisoning, swelling in the larynx allergic and inflammatory lesions, burns and injuries, poisoning vitamin D, strong acids, and organophosphorus substances quinine, chlorine, посттрансфузионные complications syndrome Mendelssohn, the bite of snakes and scorpions, anaphylactic, bloody, кардиогенный and traumatic shocks; endocrine diseases, primary or secondary deficiency надпочечников crust (preferably natural cortizone and hydrocortisone, synthetic analogues should be applied in conjunction with the минералокортикоидами) адреногенитальный syndrome loss of sodium тиреоидит, гиперкальциемия associated with cancer; Rheumatic diseases : psoriaticeski, lupus, rheumatoid uvenilny and acute gouty arthritis, ancylosing spondilit, acute and podostrae bursits, plechelopaterny periartrit et al. red systemic lupus, rheumatoid acute cardit, dermatomiozit; inflammatory and allergic diseases of the skin, including eczema and dermatitis : allergic and atopic, bullezny gerpetiformny, exfoliativei, seborainey contact; zudaschie Medicine, pemfigus, severe erythema multiformnaya Stevens-Johnson, mushroom avium, psoriasis; in ophthalmology : allergic conjunctivitis, blefarit, dermatitis century keratit, corneal ulcers, herpes zoster, irit, iridotsyklit, horioretinit inflammation front segment diffuse rear uveit and horioidit, optic neuritis, oftalmia sympathetic, condition after surgeries; sarkoidoz, Leffler syndrome, berillios, fulminannetary or disseminated tuberculosis lung aspirazionny pnevmonit; trombozitopenica idiopathic purpura in adults, Autoimmune Hemolytic disease and gipoplastical anaemia, eritroblastopenia, palliative therapy leukaemia and cancer in adults, acute leukaemia in children; argued syndrome without signs of uremia (to minimize proteinurii and induction diureza), severe acute nonspecific ulcerative colitis and ulcerative disease, TB meningitis with subarahnoidalnam stack, trihinoz with neurological and miocardialnami manifestations, acute manifestations of MS, disseminated lung cancer (additional therapy). Endoprothesis and periartikulyarnoe introduction (hydrocortisone acetate) : jet sinovit (incl. in deforming osteoartroze), rheumatoid arthritis, acute and podostrae bursits, podagric acute arthritis, epikondilita, acute nonspecific tendoshinovita, carpus syndrome channel osteoartrita post. Q / to the келлоидах localized гипертрофических, infiltrative, inflammatory lesions, low inhabitants, псориатических ff9 бляшках, кольцевидной гранулеме, нейродермите, дискоидной red волчанке, диабетическом липидном некробиозе, гнездной алопеции, tough tumors апоневроза and tendons; Differential diagnosis of hypertension and lekarstvenno induced radiation.

Contraindications

Hypersensitivity, systemic fungal infections, acute psychosis, severe arterial hypertension, декомпенсированный diabetes heavy currents, saying disease stomach and duodenal ulcer in the process of being increased, diseases (tuberculosis, Mycobacterium, viral diseases, syphilis, etc.) and ulcerative skin, the wounds tumor diseases of the skin, osteoporosis, a disease Кушинга, тромбофилические condition, kidney failure, herpes fever, viral and fungal diseases of the eye, tuberculosis eyes, trachoma, defeated eye cancer, AIDS, prior Arthroplasty, of the imposition of gastrointestinal anastomoza, pregnancy, breast-feeding, child younger age (because of the content of benzyl alcohol).

Side-Effects

Headache, dizziness, euphoria, insomnia, depression, psychosis; Allergic reactions (up to arginine); In the long-term use : otechny syndrome, exposed skin, hyperpigmentation, convulsions, Kushinga syndrome, lower tolerance to glukoze, giperglikemia, steroidnyi diabetes, the lack of napochechnikov, obstruction of menstrual flow, gipokaliemia, gipokaliemicski alkaloz, giperuriquemia (especially in acute leukaemia), the weakening of memory, the vnutricerepnogo pressure miopatia, artralgia, artropatia, osteoporosis, arterial hypertension, vasculit, worsening ulcers stomach and duodenal ulcers, a rear subkapsuliarna cataracts, glaucoma with possible damage to optic nerve, and increased risk of viral and fungal eye, the increased tension latent infection. The long local application, especially in tight bands or large parts of the skin : systemic side effects, may cause local irritation.

Patient interaction

Barbiturates, противоэпилептически е and antipruritic drugs reduce effectiveness. NPVS increase the risk azwoobrazovania in blood, paracetamol - gepatotoksicnosti. Decreases activity salicilatov, protivodiabeticakih funds increases anti-, oral saharosnijath funds. Heart glycosides and nekalisberegate dioretiki potenziruut gipokaliemia, 25.06.1997 Improvement gidrofilnosti tissue. When combined with amfoteritinom In perhaps the dilatatingo defeat attacks and congestive heart failure.

Precautions

During the period of treatment is not recommended vaccinations. The large doses allowed for a period not to exceed 72 hours Endoprothesis introduction should be no more than one every three weeks, in a strict upgrades and wood, and only after that an infectious process in the foot. V / m is a possible deeper into gluteus muscle therapy to prevent muscle atrophy. With long-term therapy to control the content of potassium in the blood (and his appointment), and regular Ekg-issledovania. In order to prevent the development of secondary gipokortitizma caused by the cancellation of the treatment, the dosage must decline gradually. Glukokortikoida may mask some of the infection may join new infections arise from the reduction of resistance. When treating korticosteroidami or combined with other drugs, shock cellular, humoral immunity or Klebsiella function may be different viral, bacterial, fungal, protosanae infections and worms invasions protekavschie latentno earlier. The risk of infection and the more serious the current increases in proportion to the increase in dosage.

Dosing and Administration

In / in or / m 50-300 mg / day to 1,500 mg. In / in slow drip or 500 ml physiological solution, or 5% solution Glukozy.vnutri- and periartikulyarno - 5-25 mg or more children from 3 months to 1 year 25 mg, 1-6 years, 25-50 mg, 6-14 years, 50-75 mg. For acute, life-threatening conditions, to 100-150 mg every 4 h for 48 h, and then every 12 hours, or 100 to 500 during the 30 seconds, and the same dose at intervals of 1, 3, 6 and 10 h after the first injection. Children every 6700 1-2 mg / kg, the optimal daily dose of 6-9 mg / Kg.forma for local applications is the thin layer of the skin at the affected areas 2-3 times a day. In chronic lichenizirovannah, gipertroficskih skin manifestations apply under occluzie bandages, alternate every 24 to 48 hours Eye ointment give kongungualny bag 2-3 times a day.

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