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Endocrine Disorders, Contraception, and Hormone Therapy during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Prednisone and prednisolone are synthetic glucocorticoids. Prednisone is biologically inert but is metabolized in first pass through the liver to prednisolone, a biologically active compound. Prednisone and prednisolone are used for replacement therapy and to treat a variety of allergic and inflammatory conditions.
Adrenal insufficiency
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Glucocorticoid doses do not typically need to be increased during early pregnancy. However, rises in CBG may lead to a higher hydrocortisone dosing requirement later in pregnancy. A common clinical approach is to increase hydrocortisone doses by 20–40% starting in the second or third trimester.32
Autoimmune disorders that can be mistaken for viral illness
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Maxwell Greene, Eric Lancaster
Steroid therapy is often used for autoimmune encephalitis; however, there are many considerations regarding the side effects and interaction with particular disease states. Glucocorticoids can have many diverse side effects that are generally cumulative dose in onset which can include glucose intolerance that can lead to diabetes, long-term demineralization of bone, central obesity/cushingoid features and weight gain in general, thinned skin, open angle glaucoma, cataracts, insomnia, gastric ulceration, long term immunosuppression, and in rare cases, perforated viscus, or extreme anxiety and other mood changes including hallucination, are possible. To mitigate these risks a proton pump inhibitor or H2 blocker is traditionally prescribed with doses of prednisone above 10 mg daily. Vitamin D is normally recommended with longer steroid treatments. After prolonged steroid use, screening with dual-energy x-ray absorptiometry (DEXA) scan is recommended. Additionally, with high doses (usually above 15 mg of prednisone daily) antibiotics are used for prophylaxis against pneumocystis pneumonia. The course of steroid treatment depends on the particular diagnosis. For example, with anti-NMDAR encephalitis we usually use a rapid taper, but with LGI1 antibodies we taper steroids slowly over many months. In general, steroids should be slowly reduced to the smallest dose that provides effective treatment benefit.
Cues associated with repeated ethanol exposure facilitate the corticosterone response to ethanol and immunological challenges in adult male Sprague Dawley rats: implications for neuroimmune regulation
Published in The American Journal of Drug and Alcohol Abuse, 2023
Jamie E. Mondello, Anny Gano, Andrew S. Vore, Terrence Deak
Our first finding was that i.p. ethanol paired rats showed an increase in CORT levels 3 h after exposure to the CS+. This matches findings that were previously published from the same study, in which paired rats that received i.p. ethanol training, but not i.g. training, showed elevated IL-6 expression in the amygdala and hippocampus (13). These results suggested that conditioning of the immune response and HPA-axis to alcohol may occur in concert. This is not surprising, given the strong reciprocal interactions evident between the two systems (22,31). Both the immune system and HPA-axis are highly activated by physiological and immune stressors. Classically, glucocorticoids have been recognized as exerting a suppressive and anti-inflammatory control on the immune system. Glucocorticoids can have a priming and pro-inflammatory effect as well; however, the circumstances that determine the regulatory role of glucocorticoids on the immune system are not fully understand (32,33). The immune response has been shown, in turn, to act directly on many parts of the HPA-axis. While IL-1 and IL-6 stimulate glucocorticoid release from the adrenal glands, TNFα appears to have inhibitory control on glucocorticoid release (reviewed in: 34). With regard to alcohol, recent data from our lab indicate that CORT may be necessary for the induction of IL-6 by ethanol, as well as the suppression of IL-1 and TNFα observed during acute ethanol intoxication (23). Thus, the present findings on conditioning of the CORT response to alcohol have important implications for classical conditioning of neuroimmune responses.
Dexamethasone increases renal free fatty acids and xanthine oxidase activity in female rats: could there be any gestational impact?
Published in Drug and Chemical Toxicology, 2022
Olufunto O. Badmus, Isaiah W. Sabinari, Lawrence A. Olatunji
It is well established that glucocorticoids given during pregnancy may result in some maternal metabolic derangements. From our previous finding, late-gestational DEX administration caused insulin resistance (IR), dyslipidemia, and glucose deregulation that are accompanied by increased uric acid, endoglin, which are cardiovascular inflammatory markers (Badmus et al. 2018). Also, dipeptidyl peptidase-4 activity (DPP-4) was heightened in DEX-treated rats independent of glycogen synthase kinase-3 (GSK-3) (Badmus et al. 2018, Badmus and Olatunji 2019). However, no study has provided information on renal metabolic effects of late gestational DEX administration, particularly its impact on FFAs, the major energy substrate for the kidney. This study further sought to investigate the possible modulatory role of pregnancy on DEX-induced renal impairments in female Wistar rats.
Vaccination and their importance for lung transplant recipients in a COVID-19 world
Published in Expert Review of Clinical Pharmacology, 2021
Samantha Scharringa, Thijs Hoffman, Diana A. van Kessel, Ger T. Rijkers
Corticosteroids are a group of compounds that mimic the endogenous steroid hormones produced in the adrenal cortex. Corticosteroids are divided into two classes: mineralocorticoids which regulate electrolyte and fluid homeostasis, and glucocorticoids which have anti-inflammatory properties [7]. Some of the most commonly prescribed glucocorticoids are prednisone and dexamethasone. Although dexamethasone has been found to be seven times more potent than prednisone on a weight for weight basis, it also has more side effects. Due to this fact, dexamethasone has been reserved for patients who do not respond to prednisone or whose symptoms cannot be controlled by prednisone [8]. In transplant medicine, corticosteroids are used to prevent organ rejection by starting at high doses after surgery and slowly tapering to a reach a maintenance dose.