Steroids in oral and maxillofacial surgery
- 1. Steroids in omfs DR.PRATHIBA 1ST YEAR MDS DEPT OF ORAL AND MAXILLOFACIAL SURGERY AJIDS
- 2. CORTICOSTEROIDS • The term “corticosteriods”(also called simply steroids) refers both to the hormones produced in outer layer(cortex) of adrenal glands and to the modified forms of these hormones that are used as drugs.
- 3. HISTORY OF STEROID THERAPY EDWARD C. KENDALL THE DEVELOPMENT OF CORTISONE AS A THERAPEUTIC AGENT NOBEL LECTURE, DECEMBER 11, 1950
- 6. DEVELOPMENT REVIEW OF MEDICAL EMBRYOLOGY BOOK BY BEN PANSKY ,PHD , M.D
- 8. STEROIDS BIOSYNTHESIS • Corticoids are 21 carbon compounds having a cyclopentanoperhydro-phenanthene(steroid) nucleus. Since adrenal cortical cells store only minute quantity of hormone ,rate of release is governed by the rate of biosynthesis. Rate of secretion of the principal steroids Glucorticoids 10-20 mg daily Mineralocorticoids – 0.125 mg daily
- 10. TRANSPORT OF ADRENOCORTICAL HARMONES • In blood they reversibly bind with alpha globulin called transcortin or corticosteroids binding globulin • Small amounts bind loosely to the albumin Bioavailability: Hydrocortisone undergoes high first pass metabolism,has low oral: parentral activity ratio. Oral bioavailability of synthetic corticoids is high. Transcortin 75% Albumin 5% Free form 20%
- 11. Metabolism and excretion of cortico steroids Degraded mainly in liver • Conjugated to form glucuronides and to a lesser extent form sulphates • 25% - excreted in bile and feces • 75% - excreted in urine Metabolism: Basal Cortisol Production = 8-25 mg/24hrs Cortisol Production can be 6-fold in stress Metabolism by liver enzymes excretion by urine plasma t1/2 of cortisol 60-90 min in circulation. biological t1/2 is longer-effects persist long after steroid is removed from plasma.
- 12. Regulation of glucocorticoids secretion HPA AXIS & NEGATIVE FEEDBACK MECHANISM
- 14. Measures to minizmize the hpa axis suppression • Use of short acting steroids at lowest possible dose • Use of steroid for shorest period of time • Giving entire daily dose one time in morning • Switch to alternate day therapy
- 16. STRESS AND ADRENAL GLANDS
- 18. Adrenal crisis • Life-threatening emergency characterised by collapse ,sbradycardia,hypotension,profound weakness,hypoglycemia,vomiting,and dehydration
- 19. • The early indicators of an adrenal-crisis onset can be vague and non-specific. • Management: • Lay patient flat and leg raised • Give 200 mg hydrocortisone i.v. and summon medical assistance • Take blood for glucose and electrolyte estimation • Give glucose if there is hypoglycemia(25 mg orally or i.v.) • Put up an infusion of NS or glucose –saline. • Give I litre. For two hours together with 200mg hydrocortisone sodium succinate,repeating this at 4-6 hourly intervals as req. and monitor b.p. • Determine and deal with underlying cause,control of pain &infection • Steroids supplementation must be continued for 3 days after the b.p.has retuned to normal.
- 22. Pharmacological actions • Direct Actions – eg anti inflammatory , anti allergy , anti immunity • Permissive Actions • Calorigenic effect of glucagon. • Lypolytic effect of catecholamines. • Pressor effect of catecholamines. • Bronchodilation by catecholamines.
- 23. Actions of steroids • Mineralocorticoids ➢Source : Zona glomerulosa ➢Functions: 90% of mineralocorticoid activity is provided by aldosterone ➢Aldosterone – life saving hormone
- 25. • Action on • Sodium metabolism • Increases sodium reabsorption from renal tubules • Sodium reabsorption, stimulates water reabsorption thus in term increases ECF volume • Increases • Potassium ions • Increases in excretion of potassium ion s from renal tubules • On ECF • Tubular secretion of hydrogen ion , essential to maintain acid base balance. • Blood pressure • Increases blood pressure
- 26. Electrolyte and water balance
- 27. Glucocorticoid actions •Source : zona fasciculata •Functions • Cortisol – Life protecting hormone
- 30. On specific tissues Calcium metabolism ↓ Intestinal absorption ↑Renal excretion OSTEOPOROSIS-spongy bones are more sensitive(e.g., vertebrae, ribs etc) Cardiovascular system Restrict capillary permeability Maintain tone of arterioles & Myocardial contractility Na+ sensitize blood vessels to the action of catecholamines & angiotensin-(permissive role in development of hypertension ,should be used cautiously in hypertensives)
- 31. Skeletal muscle Optimum level of corticosteroid is needed for normal muscular activity. Hypocorticisim : ↓ work capacity & weakness Hypercorticism: •excess mineralocorticoid action - hypokalemia – weakness •excess glucocorticoid action - muscle wasting & myopathy - weakness CNS Direct: Mood(mild euphoria),Behaviour,Brain excitability,High doses lower seizure threshold-cautious use in epileptics Indirect: maintain glucose, circulation and electrolyte balance
- 32. Stomach ↑ section of gastric acid &pepsin&↓ in PG levels in the stomach--Cytoprotective effect of PG lost--result- -peptic ulcer Misoprostol ( A prostaglandin E1, analogue) may be used to replenish the depleted stomach PGS Lymphoid tissue and Blood cells •Lymphoid tissue: • ↑ rate of destruction of lymphoid cells(T cells are more sensitive than B cells) •Blood cells: ↑ number of RBCs,platlets,neutrophils in circulation. ↓ lymphocytes,eosinophils and basophils blood count come back normal after 24 hours.
- 33. Growth & Cell division the process of healing and scar formation. Retards the growth of children Respiratory system •Most potent and most effective anti-inflammatory •Effects not seen immediately (delay 6 or more hrs) •Inhaled corticosteroids are used for long term control in bronchial asthma.
- 34. Anti inflammatory and immunosuppressive effects Causes greater suppression of CMI (graft rejection & delayed hypersensitivity) ↓Transplant rejection: ↓antigen expression from grafted tissues, ↓sensitisation of T lymphocytes. Which makes the basis of use in autoimmune diseases and organ transplantation.
- 36. Different preparations • Glucocorticoids Short acting Intermediate acting Long acting • Mineralocorticoids • Inhalant steroids • Topical steroids SYNTHETIC STEROIDS have largely replaced the natural compound s in therapeutic use ,because they are potent,longer acting,more selective,for glucu/mineralo action and have high oral activity
- 39. Equivalent drug doses (British National Formulary, March 2003) Prednisolone 10 mg is equivalent to • Betamethasone 1.5 mg • Cortisone acetate 50 mg • Dexamethasone 1.5 mg • Hydrocortisone 40 mg • Methylprednisolone 8 mg
- 41. Uses of steroids Replacement therapy(for endocrine diseases) Pharmacotherapy( for non-endocrine diseases) Diagnostic uses
- 42. Therapeutic priniciples Long term use is potentially hazardous.keep dose to minimum which is found by trial & error; Needs frequent evaluation. Single dose: No harm ,can be used to tide over mortal crisis. Few days therapy (even high doses)unlikely to be harmful Infection, severe trauma or any stress during therapy:↑ dose Use is only palliative (except replacement therapy) Abrupt cessation of prolonged high dose(>2-3 weeks) leads to adrenal insufficiency
- 43. Replacement therapy 1.Acute adrenal insufficiency: an emergency Hydrocortisone Amount of fluid infused-governed by-b.p. 2.Chronic adrenal insufficiency: (addison’s disease): Hydrocortisone given orally, Supplemented with –a mineralocorticoid (fludrocortisone) 3.Congenital adrenal hyperplasia Familial disorder due to def. of of 21- hydroxylase &11 - hydroxylase enzyme. Treatment : hydrocortisone 0.6 mg /kg/day in divided doses .
- 44. Non therapeutic uses 1.arthritis: rheumatoid ,osteoarthritis , rheumatic fever , gout 2.Collegen diseses:SLE,polyarteritis nodosa,dermatomyostitis,nephrotic syndrome,glomerulonephritis May be life saving Started with high dose-tapered to maintainance dose when remission occurs. 3.Severe allergic reactions: anaphylaxis,angioneurotic edema,urticaria,serum sickness. Even i.v. inj takes 1-2 hours to act,So not a substitute to adr.in anaphylaxis and angioedema of larynx.
- 45. • 4.Autoimmune diseases : • Hemolytic anaemia , trombocytopenia , MS, active chronic hepatitis , myasthenia gravis. • 5.Bronchial asthma: Status asthmaticus ,Severe chronic asthma:as a supplement to bronchodilators. • 6.Other lung diseases: • Aspiration pneumonia,pulmonary edema ,for lung maturation in foetus ,to prevent RDS in cases of premature delivery. • 7.Infective diseases : • Under effective chemotherapeutic cover , corticosteroids are indicated only in serious infective diseases to tide over crisis or to prevent complication.
- 46. • 4.Autoimmune diseases : • Hemolytic anaemia , trombocytopenia , MS, active chronic hepatitis , myasthenia gravis. • 5.Bronchial asthma: Status asthmaticus ,Severe chronic asthma:as a supplement to bronchodilators. • 6.Other lung diseases: • Aspiration pneumonia,pulmonary edema ,for lung maturation in foetus ,to prevent RDS in cases of premature delivery. • 7.Infective diseases : • Under effective chemotherapeutic cover , corticosteroids are indicated only in serious infective diseases to tide over crisis or to prevent complication.
- 47. • 4.Autoimmune diseases : • Hemolytic anaemia , trombocytopenia , MS, active chronic hepatitis , myasthenia gravis. • 5.Bronchial asthma: Status asthmaticus ,Severe chronic asthma:as a supplement to bronchodilators. • 6.Other lung diseases: • Aspiration pneumonia,pulmonary edema ,for lung maturation in foetus ,to prevent RDS in cases of premature delivery. • 7.Infective diseases : • Under effective chemotherapeutic cover , corticosteroids are indicated only in serious infective diseases to tide over crisis or to prevent complication.
- 48. • 14. Shock • Septicaemic shock. • 15.Organ tranplant and skin allograft: • High dose corticosteroids +other immunosuppressants to prevent rejection followed by low maintenance dose. 16. Miscellaneous With chemotherapy(antiemetic),Bell’s palsy,Thrombocytopenia,Spinal cord injury,Sarcoidosis ,Hypercalcemia,IBD
- 49. Diagnostic uses • Cushing’s syndrome To locate the source of androgen production in hirusitism
- 50. pulsetherapy • Also called short term therapy • High dose therapy involves a 48-72 hrs course of intensive steroid administration • Single i.v injection of a supra- physiological dose of steroid • Dose of 0.5-2g of prednisolone or equivalent Pulse Steroid Therapy Aditi Sinha and Arvind Bagga Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences New Delhi, India Indian Journal of Pediatrics, Volume 75—October, 2008
- 51. ALTERNATE DAY THERAPY • Double dose is taken every other morning • Usually preferred for other chronic conditions. • Schedule allows rest periods so that adverse effects are decreased while anti- inflammatory effects continue. • ADT is used only for maintenance therapy • ADT can be started after symptoms have subsided and stabilized.C
- 54. Rule of two • The rule of two states that adrenal suppression may occur if a patient is taking • 20mg of cortisone or its equivalent daily , • for 2 weeks • within 2 years
- 55. Adverse effects A Comprehensive Review of the Adverse Effects of Systemic Corticosteroids David M. Poetker, MD, MAa,b, *, Douglas D. Reh, MD Clinics of north America
- 56. A Comprehensive Review of the Adverse Effects of Systemic Corticosteroids David M. Poetker, MD, MAa,b, *, Douglas D. Reh, MD Clinics of north America
- 57. Cushing syndrome Dental management in these patients consists in ---LA is preffered for pain control. preventionof infections pathological fractures during surgical treatments complications such as hypertension,CVS problems, hyperglycemia, depression and delayed healing. Consider supplementation. If the steroid dose is reduced too quickly after replacement therapy in post surgical patients with cushing syndrome,,features:letharg y,abdominal pain,hypotention, scaly desquamation of facial skin,paticularly of forehead,is a characteristic sign.
- 59. Addison’s disease • Addison’s disease (also Addison disease, chronic adrenal insufficiency, hypocortisolism, and hypoadrenalism) is a rare, chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid hormones (glucocorticoids and often mineralocorticoids).
- 60. Perioperative management of patients with adrenal insufficiency
- 61. Contraindications Peptic ulcer Diabetes mellitus Osteoporosis Psychosis Epilepsy Renal failure Hypertension Pregnancy Herpes simplex keratitis Tuberculosis
- 62. Clinical applications Oral submucous fibrosis: etiology, pathogenesis, and future researchR. Rajendran1. Bulletin of the World Health Organization, 1994, 72 (6): 985-996 Immunomodulatory drugs and systemic application of glucocorticoids and placental extract are commonly used. By opposing the action of soluble factors released by sensitized lymphocytes following activation by specific antigens, glucocorticoids act as immunosuppressive agents . These also prevent or suppress inflammatory reactions, thereby preventing fibrosis by decreasing fibroblastic proliferation and deposition of collagen.
- 63. • Injections of triamcinolone 10mg/ml diluted in 1 ml of 2% lidocaine with hyaluronidase 1500 IU, biweekly for 4 weeks. ➢ Biweekly submucosal injections of a combination of dexamethasone (4mg/ml) and two parts of hyaluronidase, diluted in 1.0 ml of 2% xylocaine with 27 gauge needle, not more than 0.2ml solution per site, for a period of 20 weeks. ➢ Significant relief of burning sensation (88%) and improvement of trismus (83%) can be seen in most patients.
- 64. Arthritis Rheumatoid arthritis - Intraarticular injection – 10 to 40 mg/ml Osteoarthritis - Intraarticular injection – 20 mg/ml(2 injections 14 days apart)
- 65. • Kondoh T et al ..Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Dec;98(6):651-6 • Aim was to compare the the clinical outcome of intra-articular irrigation and corticosteroid injection into the superior joint compartment (SJC) of patients and conventional closed reduction with IMF with fresh mandibular condyle fractures. Clinical outcome was determined by clinical examination of jaw motion, joint pain, and occlusal changes. • It was concluded that the modified treatment protocol involving intra-articular corticosteroid injection is a more effective and quick-acting modality than conventional closed reduction with IMF for functional recovery and control of clinical symptoms of patients with unilateral fresh condylar fractures Emerging intra-articular drug delivery systems for the temporomandibular joint. Mountziaris PM, Kramer PR, Mikos AG.Methods. 2009 Feb;47(2):134-40. Intra-articular injections of corticosteroids and hyaluronic acid are currently used to treat chronic painof TMJ.The most common treatment strategy is either a single injection or a series of two injections spaced 14 days apart .A single corticosteroid injection is beneficial for patients with severe TMJ pain, while further injections do not provide added pain relief, and may increase the risk of joint degeneration and other complications
- 66. In neuralgias To reduce incidence of post herpetic neuralgia: ➢ Prednisolone 20 to 30 mg/day for 7 – 10 days tapered to 10 mg/day for 1 week In addition to the aforementioned indications, corticosteroids are successfully used in the management of • Acute trigeminal nerve injuries, • Traumatic facial nerve paralysis, • Chronic facial pain, and
- 67. Ulcerative Vesiculo Erosive diseases Immunologically mediated diseases that affect the oral mucosa present with inflammation and loss of epithelial integrity, through cellular and/or humoral immunity- mediated attack on epithelial connective tissue targets. Corticosteroids play a central role in the treatment of vesiculoerosive lesions. Prednisolone therapy should be started at 1.0 mg/kg/day in patients with severe RAU and should be tapered after 1 to 2 weeks
- 68. Pemphigus Mainstay 1-2mg/kg/d. Initial dose of treatment – 0.5 mg/kg/day to 3 mg/kg/d Dose that achieves clinical control is maintained for 2-3 weeks and then gradually tapered. Lichen planus Prednisolone - 1mg/kg/d for <7 day Tapered to 10-20mg per day for 2 weeks
- 69. Keloid and hypertrophic scar (HS) pathologic overhealing → excessive production of fibrous tissue following healing of skin injuries. Topical and intralesional glucocorticoids are frequently used Triamcinolone acetonide → used in a concentration of 10-20 mg/ml
- 70. Intralesional injection of TRIAMCINOLONE can be given in a dose of 1 to 2 mg/kg/d (maximum of 60 mg). The treatment interval at 4 to 6 weeks. Central giant cell granuloma (CGCG)
- 71. Hemangiomas Prednisone at a dose of 20-30 mg/d can be given for 2 weeks to 4 months Intralesional triamcinolone acetonide (4 mg/mL)
- 72. mucocele ➢ 0.05% CLOBETASOL PROPIONATE 3 times a day for 4 weeks in a mucosal adhesive base. ➢ Intralesional injections have also been tried with success.
- 73. • Facial pain, edema, ecchymosis and limitation of mouth opening → expected sequelae of oral and maxillofacial surgeries. • Corticosteroids → control post-operative morbidities, provide comfort for patients • The most commonly administered types of corticosteroids are betamethasone, dexamethasone, and methylprednisolone, administered intravenously, orally or by injection into the masseter muscle. • To decrease post-rhinoplasty • Reduces the facial swelling, also the severity of pain after surgery. Management of post-operative morbidities associated with maxillofacial surgeries
- 77. During routine dental procedures REMEMBER: • Conducting treatment in the morning. • Control of anxiety and emotional stress. • Use long-acting anesthetics. • Treatment of postoperative pain. • Minimum use of NSAIDs • Aseptis surgery ,Antibiotic prophylaxis • Prevention of iatrogenic fracture during surgery . • topical steroids for use in mouth predispose to oral candidiosis.
- 78. References • Textbook of pharmacology , KD Tripathi • Phyisology for dental students , A.K. Jain • Medical emergencies in dentistry , Skully and Causon • A comprehensive review of the adverse effects of systemic corticosteroids david M. Poetker, MD, douglas D. Reh, MD Clinics Of North America • Review of medical embryology book By BEN PANSKY ,PHD , M.D • Corticosteroids in Dentistry, Basavaraj Kallali et al JIAOMR april 2011;23(2):128-131 • Steroids in Dentistry - A Review Sambandam V, Int. J. Pharm. Sci. Rev. Res., 22(2), Sep – Oct 2013; nᵒ 44,240-245 • Steroids Application In Oral Diseases, Int J Pharm Bio Sci 2013 Apr; 4(2): (P) 829 - 834 • INTERNET SOURCES
- 79. •THANK YOU!
Editor's Notes
- #4: It has been almost 60 years since corticosteroids were first recognized for their anti-inflammatory and immunosuppressive properties, initially in rheumatologic diseases. The beneficial effects of steroids in rheumatoid arthritis were described in 1949 by Philip S. Hench and colleagues, a discovery for which he received (together with Edward C. Kendall and Tadeus Reichstein) the Nobel Prize in medicine in 1950.1,2 Currently , corticosteroids are the drugs with one of the broadest spectrum of clinical utility.
- #5: Despite the name , corticosteroids should not be confused with anabolic steroids = bolasterone methasterone , substances that mimic the virilizing effects of testosterone and are some times used illegally by athletes to build up muscle mass.
- #6: TWO ADRENAL GLANDS LOCATED ABOVE THE KIDNEYS ; CONSISTS OF THE CAPSULE AND MEDULLA HAS NO NERVE SUPPLY LY BUT RICH VASCULAR SUPPLY SO THESE HARMONES DIRECTLY ENTER SYTEMIC CIRCULATION
- #7: Cortical area of mesodermal orgin, medulaary area of ectordermal origin cortical primordium lies btwn mesonephric blastema and gonadal primordium .At beginning of 2 months under induction of primary ureter , mesothelial cells proliferate and penetrate underlying mesenchyme multiply and difeerentiate into large acidophilic cells which surrond medullary primordium By endof 3months a second wave of coelomic cells surrounds the acidophilic cell mass. These form the definitive cortex . after birth the cortex regresses in sixe . adult structure of cortex not achieved till puberty. Medullary primordium occurs at about day 45 of gestation, results from sypathetics chain in region near the developing mesodermal primordium .While the adrenal cortex is forming the invading sympathogonia cells become arranged in clusters and cords . They do ot form nerve clusters bt rather stain yellow brown with chrome salts called chromaffin cells , at birth medulla is only slightly developed and is not yet functional . At birth glomerular zone is not precise , fasiculata is readily and directly continuous with fetal zone The fetal zone begins to regresss but is not completely gone until second year Development of definitve cortex is regulated by acth not completely differentiated until 18-25 months
- #8: MEDULA & CORTEX MEDULLA : EPINEPHRINE , NOREPINEPHRINE AND CATECHOLAMINES CORTEX : ZONA GFR
- #13: The loop is completed by the negative feedback of cortisol on the hypothalamus and pituitary the HPA axisconstitue a major part of the neuroendocrine system that controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality and energy storage and expenditure In healthy individuals, cortisol rises rapidly after wakening, reaching a peak within 30–45 minutes. It then gradually falls over the day, rising again in late afternoon. Cortisol levels then fall in late evening, reaching a trough during the middle of the night. Information about the light/dark cycle is transmitted from the retina to the paired suprachiasmatic nuclei in the hypothalamus.
- #14: ACTH is secreted in irregular pulses throughout the day which cause parallel increases in plasma cortisol . Both the frequency and the amplitude of the pulses are the greatest in the early morning. This early morning increase in ACTH release is initiated by the release of CRH (corticotropin releasing hormone) and starts approximately a couple of hours before waking. The lowest levels of ACTH in blood occur just before or after falling asleep. This results in the characteristic diurnal rhythm in ACTH and cortisol secretion This pattern is not present at birth; estimates of when it begins vary from two weeks to nine months of age.[16]_ ( diurnal rhythm) changes occur during stress illness fever trauma surgery
- #17: When you think about the adrenal glands, you should think about stress. Stress can take many forms: taking an examination, recovering from a broken bone, running away from an invading army, starvation. For human males, there is even considerable stress associated even with shopping .
- #18: General adaptation syndrome, or GAS, is a term used to describe the body's short-term and long-term reactions to stress.= alarm reaction , stage of resistance,stage of exhautioN Stage 1: alarm reaction (ar) ITS the immediate reaction to a stressor. In the initial phase of stress, humans exhibit a "fight or flight" response, which prepares the body for physical activity. However, this initial response can also decrease the effectiveness of the immune system, making persons more susceptible to illness during this phase. Stage 2: stage of resistance (sr) / ADAPTATION. During this phase, if the stress continues, the body adapts to the stressors it is exposed to. Changes at many levels take place in order to reduce the effect of the stressor. For example, if the stressor is starvation (possibly due to anorexia), the person might experienced a reduced desire for physical activity to conserve energy, and the absorption of nutrients from food might be maximized. Stage 3: stage of exhaustion (se) At this stage, the stress has continued for some time. The body's resistance to the stress may gradually be reduced, or may collapse quickly. Generally, this means the immune system, and the body's ability to resist disease, may be almost totally eliminated. Patients who experience long-term stress may succumb to heart attacks or severe infection due to their reduced immunity.
- #23: Cortisol also exerts permissive actions. This refers to the fact that the action of some hormones requires the presence of cortisol. For example,cortisol must be present in order for glucagon and catecholamines to exert their calorigenic action, and for catecholamines to exert their lipolytic effect. Sympathomimitics – amphitamine cocaine ephedrine pseudoephedrine
- #27: The renin-angiotensin system (RAS) or the renin-angiotensin-aldosterone system (RAAS) is a hormone system that regulates blood pressure and water (fluid) balance. When blood volume is low, juxtaglomerular cells in the kidneys activate their prorenin and secrete renin directly into circulation. Plasma renin then carries out the conversion of released by the liver to angiotensin I.[2] Angiotensin I is subsequently converted to angiotensin II by the enzyme angiotensin-conv erting enzyme found in the lungs. Angiotensin II is a potent vaso-active peptide that causes blood vessels to constrict, resulting in increased blood pressure. Angiotensin II also stimulates the secretion of the hormone aldosterone from the adrenal cortex. Aldosterone causes the tubules of the kidneys to increase the reabsorption of sodium and water into the blood. This increases the volume of fluid in the body, which also increases blood pressure. If the renin-angiotensin-aldosterone system is abnormally active, blood pressure will be too high. There are many drugs that interrupt different steps in this system to lower blood pressure. These drugs are one of the main ways to control high blood pressure (hypertension), heart failure,kidney failure, and harmful effects of diabetes.[3][4]
- #31: Cortisol maintains the responsiveness of vascular smooth muscle to catecholamines and therefore participates in blood pressure regulation. This is another example of a permissive action of cortisol. In adrenal insufficiency, vascular smooth muscle becomes unresponsive to catecholamines. The decreased responsiveness, together with the associated hypovolemia caused by mineralocorticoid deficiency, can result in severe hypotension.
- #34: GROWTH SUPRESSION DUE TO REDUCED GROWTH HORMONE PRODN cortisol-induced collagen loss in the skin is ten times greater than in any other tissue
- #35: DECREASES LEUCOCYTE FUNCTION , DECRESES COMPLEMENT COMPONENTS N LEVELS….DECREASES HISTAMINE MEDIATED REACTIONS AND DECREASES THE LYMPHOCYTE MONOCYTE FUNCTION…he complement system helps or “complements” the ability of antibodies and phagocytic cells to clear pathogens from an organism. It is part of the immune system called the innate immune system[1] that is not adaptable and does not change over the course of an individual's lifetime. However, it can be recruited and brought into action by the adaptive immune system. The complement system consists of a number of small proteins found in the blood, in general synthesized by the liver, and normally circulating as inactive precursors (pro-proteins)
- #39: Mifepristone usd to terminate pregnancy
- #41: aBout 30-60 mins . Inihibitionof protein synthesis