Damage from long-term glucocorticoid use
Introduction
Introduction Whether administered orally, topically, or topically, glucocorticoids produce side effects. Long-term use of glucocorticoids can cause a series of adverse reactions. Long-term use of large doses of corticosteroids can cause disorders of water, salt, sugar, protein and fat metabolism, induce or aggravate infection, induce or aggravate peptic ulcer, can cause agitation, insomnia, individual patients can induce mental illness, epilepsy patients can induce Seizures. Therefore, patients with mental illness, mental patients and epilepsy should be banned, adrenal cortical atrophy or dysfunction, rebound phenomenon and withdrawal symptoms.
Cause
Cause
1, long-term use of large doses of corticosteroids, can cause water, salt, sugar, protein and fat metabolism disorders: manifested as centripetal obesity, full moon face, hairy, weakness, hypokalemia, edema, hypertension, diabetes, etc. Clinically known as Cushing's syndrome. These symptoms can be treated without special treatment. After stopping the drug, they usually gradually resolve on their own, and can return to normal after several months or longer. If necessary, it can be combined with antihypertensive and hypoglycemic drugs, and given symptomatic treatments such as low pressure, low sugar, high protein diet and potassium supplementation. Therefore, patients with hypertension, arteriosclerosis, renal insufficiency and diabetes should be properly supplemented with vitamin D and calcium, and corticosteroids should be used with caution.
2, induced or aggravated infection: corticosteroids have anti-inflammatory effects, but do not have antibacterial effect, and can reduce the body's anti-infective ability, so that the body's disease resistance is reduced, which is conducive to bacterial growth, reproduction and spread. Therefore, long-term application of corticosteroids can induce infection or enlarge or spread the potential infection in the body, and can also spread the original resting tuberculosis. In the course of medication, attention should be paid to changes in the condition and whether infection is induced, and anti-infective treatment is given at the same time.
3, induced or aggravated peptic ulcer: in addition to obstructing tissue repair, delaying tissue healing, glucocorticoids can also increase gastric acid and pepsin secretion, reduce gastric mucus secretion, reduce gastric mucosal resistance, can induce or aggravate Gastric and duodenal ulcer bleeding, and even cause perforation of the digestive tract.
4, neurological symptoms: can occur excitement, insomnia, individual patients can induce mental illness, epilepsy patients can induce seizures. Therefore, patients with mental illness, mental patients and epilepsy should be banned.
5, adrenal cortical atrophy or dysfunction: longer-term application of this class of drugs, because the level of glucocorticoids in the body is higher than normal for a long time, can cause negative feedback, and affect the hypothalamic and anterior pituitary secretion of adrenocorticotropic hormone, so that endogenous Reduced secretion of glucocorticoids or leads to adrenocortical hormone insufficiency. In the event of stress, such as bleeding or infection, dizziness, nausea, vomiting, hypotension, hypoglycemia, or hypoglycemia may occur.
6, rebound phenomenon and withdrawal symptoms: long-term application of hormonal drugs, when the symptoms are basically controlled, if the reduction is too large or sudden withdrawal, the original symptoms can appear or increase quickly, this phenomenon is called rebound phenomenon. This is due to the patient's dependence on hormones or the symptoms are not fully controlled. The treatment measures are to restore the amount of hormones, and then slowly reduce the amount after the symptoms are controlled.
Examine
an examination
The patient is given oral, topical, or topical glucocorticoids for a long time.
Diagnosis
Differential diagnosis
1. Non-steroidal anti-inflammatory analgesics can enhance the ulceration of glucocorticoids.
2. It can enhance the hepatotoxicity of acetaminophen.
3. Aminoglutethimide inhibits adrenal function and accelerates the metabolism of dexamethasone, shortening its half-mourning period by a factor of two.
4. When combined with amphotericin B or carbonic anhydrase inhibitor, it can aggravate hypokalemia, should pay attention to changes in serum potassium and cardiac function. Long-term combination with carbonic anhydrase inhibitors, prone to hypocalcemia and osteoporosis .
5. Combined with protein anabolic hormones, it can increase the incidence of edema and make acne worse.
6. In combination with antacids, it can reduce the absorption of prednisone or dexamethasone.
7. Long-term use with anticholinergic drugs (such as atropine) can cause increased intraocular pressure.
8. Tricyclic antidepressants can aggravate the psychiatric symptoms caused by glucocorticoids.
9. When combined with hypoglycemic agents such as insulin, the amount of hypoglycemic agents should be adjusted as appropriate to increase blood glucose in diabetic patients.
10. Thyroid hormone can increase the metabolic clearance rate of glucocorticoids. Therefore, when thyroid hormone or antithyroid drugs are combined with glucocorticoids, the dose of the latter should be appropriately adjusted.
11. In combination with birth control pills or estrogens, it can strengthen the therapeutic effects and adverse reactions of glucocorticoids.
12. In combination with cardiac glycosides, it can increase the toxicity of digitalis and heart rhythm disorders.
13. In combination with potassium-sparing diuretics, it can cause severe hypokalemia, and weaken the diuretic effect of diuretics due to sodium retention.
14. In combination with ephedrine, it can enhance the metabolic clearance of glucocorticoids.
15. In combination with immunosuppressive agents, it increases the risk of infection and may induce lymphoma or other lymphoproliferative disorders.
16. Glucocorticoids, especially prednisolone, can increase the metabolism and excretion of isoniazid in the liver, reducing the blood concentration and efficacy of isoniazid.
17. Glucocorticoids promote the metabolism of mexiletine in the body and reduce blood levels.
18. In combination with salicylate, the concentration of plasma salicylate can be reduced.
19. In combination with growth hormone, it can inhibit the growth-promoting effects of the latter.
