Pain and Corticosteroids

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Author:
HuskerDevil
ID:
40592
Filename:
Pain and Corticosteroids
Updated:
2010-10-07 22:05:45
Tags:
DPAP2012 Pain Corticosteroids
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Pain and Corticosteroids
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  1. Mineralocorticoid (MC)
    • Na+ retaining
    • Increased Na+ = increased H20 = increased volume
    • Endogenous = aldosterone
    • Synthetic = fludrocortisone
  2. Glucocorticoid (GC)
    • Glucose retaining
    • Endogenous = cortisol
    • Regulation of fat, carbs, protein metabolism
    • Naturally occurring = hydrocortisone and cortisone
    • Synthetic = prednisone
  3. Corticosteroid: Mechanism of action
    Intracellular binding leads to DNA transcription--> effect lags behind dosage (takes a while to elicit a response)
  4. GC decreases inflammation and immune response by:
    • Inhibiting macrophage accumulation in inflamed areas
    • Decreased capillary permeability and edema formation
    • Antagonize histamine activity
    • Decrease immunoglobulins and passage of immune complexes via basement memb
    • Prevent release of destructive acid hydrolases from leukocytes
  5. Fentanyl
    • Opioid agonist:
    • Duragesic
    • Fentora
    • Actiq
  6. Hydrocodone/Acetaminophen
    • Opioid agonist:
    • Vicodin
    • Lorcet
    • Lortab
  7. Hydromorphone
    • Opioid agonist:
    • Dilaudid
  8. Meperidine
    • Opioid agonist:
    • Demerol
  9. Methadone
    • Opioid agonist:
    • Dolophine
  10. Morphine
    • Opioid agonist:
    • MS Contin
    • Oramorph
    • Kadian, Avinza
  11. Oxycodone
    • Opioid agonist:
    • OxyContin
  12. Oxycodone/acetaminophen
    • Opioid agonist:
    • Percocet
    • Endocet
  13. Propoxyphene
    Darvon
  14. Propoxyphene/acetaminophen
    Darvocet
  15. Buprenorphine/Naloxone
    • Opioid Partial Agonist/Antagonist:
    • Suboxone
  16. Tramadol
    • Centrally acting analgesic:
    • Ultram
    • Ryzolt
  17. Methylprednisolone
    • GC:
    • Medrol
    • Depo-Medrol
    • Solu-Medrol
  18. Cortisone/ Hydrocortisone
    • GC:
    • Short acting
    • T1/2 8-12 hrs
    • Na+ retaining
    • No anti-inflammatory
    • Equiv=25mg / 20 mg
  19. Prednisone: Prednisolone
    • GC:
    • Intermediate acting
    • T1/2 18-36 hrs
    • Moderate Na+ retaining (1)
    • Mod anti-inflamm (4)
    • Equiv=5mg
  20. Triamcinolone
    • GC:
    • Intermediate acting
    • T1/2 18-36 hrs
    • No Na+ retaining
    • Moderate anti-inflamm (5)
    • Equiv=4mg
  21. Methylprednisolone
    • GC:
    • Intermediate acting
    • T1/2 18-36 hrs
    • No Na+ retaining
    • Moderate anti-inflamm (5)
    • Equiv = 4mg
    • Dosepak (TAPER)
  22. Dexamethasone / Betamethasone
    • GC:
    • Long-acting
    • T1/2 36-55 hrs
    • No Na+ retaining
    • HIGH anti-inflamm (20-30)
    • Equiv=0.75
  23. CYP 450 enzyme induction
    Decreased substrate in blood (drug removal)
  24. CYP 450 enzyme inhibition
    Increased substrate in blood (no breakdown)
  25. P-glycoprotein (P-gp)
    • Efflux transporter
    • Excretion (decreased absorption)

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