Jenn’s Latest Troubles

Jenn’s Latest Troubles

Well, I’ve told some people and others have seen me in person (don’t worry – that’s an air conditioner in the background – not some kind of torture device) so this is going to get out and I’m just not ME if I’m not sharing. I am having some ‘troubles’ right now. I firmly believe I am going to be perfectly fine. After my treatment today John immediately wanted to go to IKEA and start designing my dream kitchen, so you know, it’s not ALL bad. Usually I just get puppies, but I’ve reached my allotment (and the person/dog per capita ratio to maintain peak sanity – or what passes for it for me).
I’ve been not really at my best for the past little while, which I related to a cold, and it is (they think) RELATED to a cold – one which I had earlier in the year (like months and months and months ago). Last Tuesday I had my usual every 3 month clinic appointment. My x-ray was shadowy in my lower lungs and my lung functioning was down 11%. Scary morning for Jenn! So I asked about my repeat CT scan I had in late April since my March one showed nodules and weird crap. Turns out it was filed away and no one passed it on to a doctor to review at the clinic. It was worse than the March one. I am putting aside my anger on that one however I did say today, “I will haunt you if you have made a ‘grave’ error”. Yes, I still have my sense of humour (as does John – kitchen building aside).
And so, two days before leaving for Edmonton for a family reunion, I found myself being prescribed antibiotics and inhalers, having yet another CT scan and an emergency bronchoscopy the following day (those are fun – no, not fun…). So it’s NOT acute rejection, it’s not a bacterial infection, it’s not fungal, it’s not pneumonia, it’s not the regular old flu or variation thereof. The only thing I test positive for is rhinovirus/enterovirus. And yes, they did okay me for travel as I wasn’t flying (you could throw an embolism flying after a bronchoscopy) as I stubbornly said what’s the use of staying home all weekend? You guys won’t have any tests back. As tests trickled in and I was emailed and saw some online I discussed them with my very knowledgeable Nurse/Sister/Cousin Christine and THANK YOU, you are really wonderful about listening to health crap when you’re on holidays.
So today I went back to clinic and my lung function decreased a further 7% from last week. Was it the margaritas? No, I really think those helped – as did the laughing with my family. Thank you to everyone who knew and did as I asked and not make me sad and talk about it much. Thanks for all the love and support (and margaritas!). Even the gorgeous drive through the mountains was a distraction. So the plan now is for 3 days of high dose IV prednisone (YAY!) along with a dose of IVIG (the nurses among you will understand that one). I’m back tomorrow and Friday and back to clinic next week and FINGERS CROSSED I will have started to improve. They are also pushing to get my neurologist to see me as hopefully it’s not related to my sucky primary disease. FINGERS CROSSED – that would be bad.
But I am okay. I’m not sitting here crying and sad. I am optimistic and I’m a tough bitch and I can make it through this. And John is designing me a lovely new kitchen, so I’m excited.

Read More…

Abiraterone acetate

Abiraterone acetate, sold under the brand name Zytiga among others, is an antiandrogen medication which is used in the treatment of prostate cancer.[1] It is specifically indicated for use in conjunction with castration and prednisone for the treatment of metastatic castration-resistant prostate cancer (mCRPC) and in the treatment of metastatic high-risk castration-sensitive prostate cancer (mCSPC).[1] It is taken by mouth once per day with food.[1]

Side effects of abiraterone acetate include fatigue, arthralgia, hypertension, nausea, edema, hypokalemia, hot flashes, diarrhea, vomiting, cough, headache, glucocorticoid deficiency, mineralocorticoid excess, and hepatotoxicity among others.[1] The drug is an androgen synthesis inhibitor – specifically, a CYP17A1 inhibitor – and thereby inhibits the production of androgens like testosterone and dihydrotestosterone in the body.[1] In doing so, it prevents the effects of these hormones in the prostate gland and elsewhere in the body.[1] Abiraterone acetate is a prodrug of abiraterone.[1]

Abiraterone acetate was first described in 1993 and was introduced for medical use in 2011.[5][6][7] It was approved for the treatment of mCRPC in 2011 and was subsequently approved for the treatment of mCSPC in 2018.[8] The medication is marketed widely throughout the world.[9] It is not available as a generic medication.[10]

Contents

  • 1 Medical uses
    • 1.1 Prostate cancer
      • 1.1.1 Clinical effectiveness
    • 1.2 Available forms
  • 2 Contraindications
  • 3 Side effects
  • 4 Overdose
  • 5 Interactions
  • 6 Pharmacology
    • 6.1 Pharmacodynamics
      • 6.1.1 Antiandrogenic activity
      • 6.1.2 Estrogenic activity
      • 6.1.3 Other activities
    • 6.2 Pharmacokinetics
  • 7 Chemistry
  • 8 History
  • 9 Society and culture
    • 9.1 Generic names
    • 9.2 Brand names
    • 9.3 Availability
  • 10 Research
  • 11 See also
  • 12 References
  • 13 External links

Medical uses[edit]

Prostate cancer[edit]

Abiraterone acetate is indicated for use in combination with prednisone, a corticosteroid, as a treatment for mCRPC (previously called hormone-resistant or hormone-refractory prostate cancer).[11][12][13][14] This is a form of prostate cancer that is not responding to first-line androgen deprivation therapy or treatment with androgen receptor antagonists. Abiraterone acetate has received FDA (28 April 2011), EMA (23 September 2011), MHRA (5 September 2011) and TGA (1 March 2012) approval for this indication.[11][12][13][14] In Australia it is covered by the Pharmaceutical Benefits Scheme when being used to treat castration-resistant prostate cancer and given in combination with prednisone/prednisolone (subject to the conditions that the patient is not currently receiving chemotherapy, is either resistant or intolerant of docetaxel, has a WHO performance status of <2, and his disease has not since become progressive since treatment with PBS-subsidised abiraterone acetate has commenced).[15]

Clinical effectiveness[edit]

A phase III study in subjects previously treated with docetaxel started in 2008.[16] In September 2010, an independent panel found that the interim results in patients previously treated with docetaxel were so much better compared to those treated with placebo that it was unethical to keep half the study participants on placebo, and all patients began receiving the drug. Overall survival was increased by 3.9 months in to this study (14.8 months versus 10.9 months for placebo).[17]

A placebo-controlled double-blind randomized phase III study in patients with castration-refractory prostate cancer but who had not received chemotherapy opened to accrual in April 2009.[18][19] 1,088 men received either abiraterone acetate (1000 mg daily) plus prednisone (5 mg twice daily), or placebo plus prednisone. The median radiographic progression-free survival was 16.5 months with abiraterone acetate–prednisone and 8.3 months with prednisone alone (hazard ratio (HR) = 0.53; 95% confidence interval (CI), 0.45 to 0.62; P<0.001). After a median follow-up period of 22.2 months, overall survival was better with abiraterone acetate plus prednisone (median not reached) compared to placebo plus prednisone (27.2 months); HR = 0.75; 95% CI, 0.61 to 0.93; P=0.01).[20]

Available forms[edit]

Abiraterone acetate is available in the form of 250 mg and 500 mg film-coated oral tablets and 250 mg uncoated oral tablets.[1] It is used at a dosage of 1,000 mg orally once per day with food in conjunction with castration (via GnRH analogue therapy or orchiectomy) and in combination with 5 mg prednisone orally twice per day.[1]

Contraindications[edit]

Contraindications include hypersensitivity to abiraterone acetate. Although documents state that it should not be taken by women who are or who may become pregnant,[12][21] there is no medical reason that any woman should take it. Women who are pregnant should not even touch the pills unless they are wearing gloves.[21] Other cautions include severe baseline hepatic impairment, mineralocorticoid excess, cardiovascular disease including heart failure and hypertension, uncorrected hypokalemia, and adrenocorticoid insufficiency.[22]

Side effects[edit]

Side effects by frequency:[11][12][13][14][22]

Very common (>10% frequency):

  • Urinary tract infection
  • Hypokalemia
  • Hypertension
  • Diarrhea
  • Peripheral edema

Common (1-10% frequency):

  • Hypertriglyceridaemia
  • Sepsis
  • Cardiac failure
  • Angina pectoris
  • Arrhythmia
  • Atrial fibrillation
  • Tachycardia
  • Dyspepsia (indigestion)
  • Rash
  • Alanine aminotransferase increased
  • Aspartate aminotransferase increased
  • Fractures
  • Hematuria

Uncommon (0.1-1% frequency):

  • Adrenal insufficiency
  • Myopathy
  • Rhabdomyolysis

Rare (<0.1% frequency):

  • Allergic alveolitis

Overdose[edit]

Clinical experience with overdose of abiraterone acetate is limited.[1] There is no specific antidote for abiraterone acetate overdose, and treatment should consist of general supportive measures, including monitoring of cardiac and liver function.[1]

Interactions[edit]

Abiraterone acetate is a CYP3A4 substrate and hence should not be administered concurrently with strong CYP3A4 inhibitors such as ketoconazole, itraconazole, clarithromycin, atazanavir, nefazodone,
saquinavir, telithromycin, ritonavir, indinavir, nelfinavir, voriconazole) or inducers such as phenytoin, carbamazepine, rifampin, rifabutin, rifapentine, phenobarbital.[22][21] It also inhibits CYP1A2, CYP2C9, and CYP3A4 and likewise should not be taken concurrently with substrates of any of these enzymes that have a narrow therapeutic index.[22][21]

Pharmacology[edit]

Pharmacodynamics[edit]

Abiraterone, the active metabolite of abiraterone acetate.
Antiandrogenic activity[edit]

Abiraterone, the active metabolite of abiraterone acetate, inhibits CYP17A1, which manifests as two enzymes, 17α-hydroxylase (IC50 = 2.5 nM) and 17,20-lyase (IC50 = 15 nM) (approximately 6-fold more selective for inhibition of 17α-hydroxylase over 17,20-lyase)[23][24] that are expressed in testicular, adrenal, and prostatic tumor tissues. CYP17A1 catalyzes two sequential reactions: (a) the conversion of pregnenolone and progesterone to their 17α-hydroxy derivatives by its 17α-hydroxylase activity, and (b) the subsequent formation of dehydroepiandrosterone (DHEA) and androstenedione, respectively, by its 17,20-lyase activity.[25] DHEA and androstenedione are androgens and precursors of testosterone. Inhibition of CYP17A1 activity by abiraterone thus decreases circulating levels of androgens such as DHEA, testosterone, and dihydrotestosterone (DHT). Abiraterone acetate, via its metabolite abiraterone, has the capacity to lower circulating testosterone levels to less than 1 ng/dL (i.e., undetectable) when added to castration.[23][26] These concentrations are considerably lower than those achieved by castration alone (~20 ng/dL).[26] The addition of abiraterone acetate to castration was found to reduce levels of DHT by 85%, DHEA by 97 to 98%, and androstenedione by 77 to 78% relative to castration alone.[26] In accordance with its antiandrogenic action, abiraterone acetate decreases the weights of the prostate gland, seminal vesicles, and testes.[27]

Abiraterone also acts as a partial antagonist of the androgen receptor (AR), and as an inhibitor of the enzymes 3β-hydroxysteroid dehydrogenase (3β-HSD), CYP11B1 (steroid 11β-hydroxylase), CYP21A2 (Steroid 21-hydroxylase), and other CYP450s (e.g., CYP1A2, CYP2C9, and CYP3A4).[22][28][29][30] In addition to abiraterone itself, part of the activity of the drug has been found to be due to a more potent active metabolite, δ4-abiraterone (D4A), which is formed from abiraterone by 3β-HSD.[31] D4A is an inhibitor of CYP17A1, 3β-hydroxysteroid dehydrogenase/Δ5-4 isomerase, and 5α-reductase, and has also been found to act as a competitive antagonist of the AR reportedly comparable to the potent antagonist enzalutamide.[31] However, the initial 5α-reduced metabolite of D4A, 3-keto-5α-abiraterone, is an agonist of the AR, and promotes prostate cancer progression.[32] Its formation can be blocked by the coadministration of dutasteride, a potent and selective 5α-reductase inhibitor.[32]

Estrogenic activity[edit]

There has been interest in the use of abiraterone acetate for the treatment of breast cancer due to its ability to lower estrogen levels.[33] However, abiraterone has been found to act as a direct agonist of the estrogen receptor, and induces proliferation of human breast cancer cells in vitro.[33] If abiraterone acetate is used in the treatment of breast cancer, it should be combined with an estrogen receptor antagonist like fulvestrant.[33] In spite of its antiandrogenic and estrogenic properties, abiraterone acetate does not appear to produce gynecomastia as a side effect.[34]

Other activities[edit]

Due to inhibition of glucocorticoid biosynthesis, abiraterone acetate can cause glucocorticoid deficiency, mineralocorticoid excess, and associated adverse effects.[35] This is why the medication is combined with prednisone, a corticosteroid, which serves as a means of glucocorticoid replacement and prevents mineralocorticoid excess.[36]

Abiraterone acetate, along with galeterone, has been identified as an inhibitor of sulfotransferases (SULT2A1, SULT2B1b, SULT1E1), which are involved in the sulfation of DHEA and other endogenous steroids and compounds, with Ki values in the sub-micrmolar range.[37]

Pharmacokinetics[edit]

After oral administration, abiraterone acetate, the prodrug form in the commercial preparation, is converted into the active form, abiraterone. This conversion is likely to be esterase-mediated and not CYP-mediated. Administration with food increases absorption of the drug and thus has the potential to result in increased and highly variable exposures; the drug should be consumed on an empty stomach at least one hour before or two hours after food. The drug is highly protein bound (>99%), and is metabolised in the liver by CYP3A4 and SULT2A1 to inactive metabolites. The drug is excreted in feces (~88%) and urine (~5%), and has a terminal half-life of 12 ± 5 hours.[21]

Chemistry[edit]

See also: Steroidal antiandrogen and List of steroidal antiandrogens

Abiraterone acetate, also known as 17-(3-pyridinyl)androsta-5,16-dien-3β-ol acetate, is a synthetic androstane steroid and a derivative of androstadienol (androsta-5,16-dien-3β-ol), an endogenous androstane pheromone. It is specifically a derivative of androstadienol with a pyridine ring attached at the C17 position and an acetate ester attached to the C3β hydroxyl group. Abiraterone acetate is the C3β acetate ester of abiraterone.

History[edit]

In the early 1990s, Mike Jarman, Elaine Barrie, and Gerry Potter of the Cancer Research UK Centre for Cancer Therapeutics in the Institute of Cancer Research in London set out to develop drug treatments for prostate cancer. With the nonsteroidal androgen synthesis inhibitor ketoconazole as a model, they developed abiraterone, filing a patent in 1993 and publishing the first paper describing it the following year.[5][38] Rights for commercialization of the drug were assigned to BTG, a UK-based specialist healthcare company. BTG then licensed the product to Cougar Biotechnology, which began development of the commercial product.[39] In 2009, Cougar was acquired by Johnson & Johnson, which developed and sells the commercial product, and is conducting ongoing clinical trials to expand its clinical uses.[40]

Abiraterone acetate was approved by the United States Food and Drug Administration on April 28, 2011.[6][7] The FDA press release made reference to a phase III clinical trial in which abiraterone use was associated with a median survival of 14.8 months versus 10.9 months with placebo; the study was stopped early because of the successful outcome.[41] Abiraterone acetate was also licensed by the European Medicines Agency.[42] Until May 2012 the National Institute for Health and Clinical Excellence (NICE) did not recommend use of the drug within the NHS on cost-effectiveness grounds. This position was reversed when the manufacturer submitted revised costs.[43] The use is currently limited to men who have already received one docetaxel-containing chemotherapy regimen.[44][45]

Society and culture[edit]

Generic names[edit]

Abiraterone acetate is the generic name of the drug and its USAN, BANM, and JAN, while abiraterone is the INN and BAN of abiraterone, its deacetylated form.[9] Abiraterone acetate is also known by its developmental code names CB-7630 and JNJ-212082, while CB-7598 was the developmental code name of abiraterone.[9][46]

Brand names[edit]

Abiraterone acetate is marketed by Janssen Biotech (a subsidiary of Johnson & Johnson) under the brand name Zytiga.[9] In addition, Intas Pharmaceuticals markets the drug under the brand name Abiratas, Cadila Pharmaceuticals markets the drug as Abretone, and Glenmark Pharmaceuticals as Abirapro.[citation needed]

Availability[edit]

Abiraterone acetate is marketed widely throughout the world, including in the United States, Canada, the United Kingdom, Ireland, elsewhere in Europe, Australia, New Zealand, Latin America, Asia, and Israel.[9]

Research[edit]

Abiraterone acetate is under development for the treatment of breast cancer and ovarian cancer and as of March 2018 is in phase II clinical trials for these indications.[46] It was also under investigation for the treatment of congenital adrenal hyperplasia, but no further development has been reported for this potential use.[46] An oral ultramicrosize tablet formulation of abiraterone acetate (also known as abiraterone acetate fine particle (AAFP) or submicron abiraterone acetate) with improved bioavailability is in pre-registration in the United States for the treatment of prostate cancer as of April 2018 and has the tentative brand name Yonza.[47]

See also[edit]

  • List of investigational hormonal agents § Androgenics

References[edit]

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  • ^ Attard G, Belldegrun AS, de Bono JS (December 2005). “Selective blockade of androgenic steroid synthesis by novel lyase inhibitors as a therapeutic strategy for treating metastatic prostate cancer”. BJU International. 96 (9): 1241–6. doi:10.1111/j.1464-410X.2005.05821.x. PMID 16287438. 
  • ^ a b c Small EJ (November 2014). “Can targeting the androgen receptor in localized prostate cancer provide insights into why men with metastatic castration-resistant prostate cancer die?”. Journal of Clinical Oncology. 32 (33): 3689–91. doi:10.1200/JCO.2014.57.8534. PMID 25311216. Abiraterone acetate is a prodrug for abiraterone, a CYP17 inhibitor, which has the capacity to lower serum testosterone levels to less than 1 ng/dL (compared with levels closer to 20 ng/dL that are achieved with conventional ADT).19 […] Relative to LHRHa alone, the addition of abiraterone resulted in an 85% decline in dihydrotestosterone (DHT) levels, a 97% to 98% decline in dehydroepiandrosterone (DHEA) levels, and a 77% to 78% decline in androstenedione levels. 
  • ^ Tindall DJ, James M (20 April 2009). Androgen Action in Prostate Cancer. Springer Science & Business Media. pp. 748–. ISBN 978-0-387-69179-4. 
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  • ^ Malikova, Jana; Brixius-Anderko, Simone; Udhane, Sameer S.; Parween, Shaheena; Dick, Bernhard; Bernhardt, Rita; Pandey, Amit V. (2017). “CYP17A1 inhibitor abiraterone, an anti-prostate cancer drug, also inhibits the 21-hydroxylase activity of CYP21A2”. The Journal of Steroid Biochemistry and Molecular Biology. 174: 192–200. doi:10.1016/j.jsbmb.2017.09.007. ISSN 1879-1220. PMID 28893623. 
  • ^ Udhane, Sameer S.; Dick, Bernhard; Hu, Qingzhong; Hartmann, Rolf W.; Pandey, Amit V. (2016). “Specificity of anti-prostate cancer CYP17A1 inhibitors on androgen biosynthesis”. Biochemical and Biophysical Research Communications. 477 (4): 1005–1010. doi:10.1016/j.bbrc.2016.07.019. ISSN 1090-2104. PMID 27395338. 
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  • ^ a b Li Z, Alyamani M, Li J, Rogacki K, Abazeed M, Upadhyay SK, Balk SP, Taplin ME, Auchus RJ, Sharifi N (May 2016). “Redirecting abiraterone metabolism to fine-tune prostate cancer anti-androgen therapy”. Nature. 533 (7604): 547–51. doi:10.1038/nature17954. PMID 27225130. 
  • ^ a b c Capper CP, Larios JM, Sikora MJ, Johnson MD, Rae JM (May 2016). “The CYP17A1 inhibitor abiraterone exhibits estrogen receptor agonist activity in breast cancer”. Breast Cancer Research and Treatment. 157 (1): 23–30. doi:10.1007/s10549-016-3774-3. PMID 27083183. 
  • ^ Alesini D, Iacovelli R, Palazzo A, Altavilla A, Risi E, Urbano F, Manai C, Passaro A, Magri V, Cortesi E (2013). “Multimodality treatment of gynecomastia in patients receiving antiandrogen therapy for prostate cancer in the era of abiraterone acetate and new antiandrogen molecules”. Oncology. 84 (2): 92–9. doi:10.1159/000343821. PMID 23128186. 
  • ^ Figg WD, Chau CH, Small EJ (14 September 2010). Drug Management of Prostate Cancer. Springer Science & Business Media. p. 97. ISBN 978-1-60327-829-4. 
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  • ^ Yip CK, Bansal S, Wong SY, Lau AJ (April 2018). “Identification of Galeterone and Abiraterone as Inhibitors of Dehydroepiandrosterone Sulfonation Catalyzed by Human Hepatic Cytosol, SULT2A1, SULT2B1b, and SULT1E1”. Drug Metabolism and Disposition. 46 (4): 470–482. doi:10.1124/dmd.117.078980. PMID 29436390. 
  • ^ “A new way to treat prostate cancer: The story of abiraterone”. The Institute of Cancer Research. 2012-09-10. Retrieved 2012-11-12. 
  • ^ “Abiraterone Acetate (CB7630)”. Cougar Biotechnology. Archived from the original on 7 September 2008. Retrieved 2008-08-20. 
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  • ^ “EMA assessment of Zytiga (abiraterone)”. European Medicines Agency. 
  • ^ “Prostate cancer (metastatic, castration resistant) – abiraterone (following cytoxic therapy): final appraisal determination guidance” (PDF). NICE guidance. 15 May 2012. Archived from the original (PDF) on February 19, 2013. 
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  • ^ a b c “Abiraterone acetate – Johnson & Johnson”. Adis Insight. 
  • ^ “Abiraterone acetate – Churchill Pharmaceuticals”. Adis Insight. 
  • External links[edit]

    • Zytiga (abiraterone acetate) – Official website
    • Abiraterone acetate – AdisInsight

    AntiandrogensAntigonadotropins

    • D2 receptor antagonists (prolactin releasers) (e.g., domperidone, metoclopramide, risperidone, haloperidol, chlorpromazine, sulpiride)
    • Estrogens (e.g., bifluranol, diethylstilbestrol, estradiol, estradiol esters, ethinylestradiol, ethinylestradiol sulfonate, paroxypropione)
    • GnRH agonists (e.g., leuprorelin)
    • GnRH antagonists (e.g., cetrorelix)
    • Progestogens (incl., chlormadinone acetate, cyproterone acetate, hydroxyprogesterone caproate, gestonorone caproate, medroxyprogesterone acetate, megestrol acetate)

    Others

    • Androstenedione immunogens: Androvax (androstenedione albumin)
    • Ovandrotone albumin (Fecundin)
    • #WHO-EM
    • ‡Withdrawn from market
    • Clinical trials:
      • †Phase III
      • §Never to phase III

    See also
    Androgen receptor modulators
    Estrogens and antiestrogens
    Progestogens and antiprogestogens
    List of androgens/anabolic steroids
    GPRC6A
    See also
    Receptor/signaling modulators
    Androgens and antiandrogens
    Estrogen receptor modulators
    Progesterone receptor modulators
    List of androgens/anabolic steroids

    GPER
    See also
    Receptor/signaling modulators
    Estrogens and antiestrogens
    Androgen receptor modulators
    Progesterone receptor modulators
    List of estrogens


    Source: https://en.wikipedia.org/wiki/Abiraterone_acetate

    Neurosarcoidosis

    <h1>Neurosarcoidosis</h1>

    Neurosarcoidosis

    Neurosarcoidosis is a complication of sarcoidosis in which inflammation occurs in the brain, spinal cord, and other areas of the nervous system.

    Read More…

    [Articles] Custirsen (OGX-011) combined with cabazitaxel and prednisone versus cabazitaxel and prednisone alone in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel (AFFINITY): a randomised, open-label, international, phase 3 trial

    <h1>[Articles] Custirsen (OGX-011) combined with cabazitaxel and prednisone versus cabazitaxel and prednisone alone in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel (AFFINITY): a randomised, open-label, international, phase 3 trial</h1>

    [Articles] Custirsen (OGX-011) combined with cabazitaxel and prednisone versus cabazitaxel and prednisone alone in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel (AFFINITY): a randomised, open-label, international, phase 3 trial

    We noted no survival benefit in men with metastatic castration-resistant prostate cancer with the addition of custirsen to cabazitaxel and prednisone treatment. Cabazitaxel and prednisone remains the standard of care for patients with metastatic castration-re…

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    PPD Skin Test

    PPD Skin Test

    The PPD skin test is a method used to diagnose silent (latent) tuberculosis (TB) infection. PPD stands for purified protein derivative.

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    <h1></h1>

    Hal9000 replied the topic: Fostamatinib, low dose prednisone, and high dose nplate triple therapy?

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    Glucocorticoid

    <h1>Glucocorticoid</h1>

    Glucocorticoids are a class of corticosteroids, which are a class of steroid hormones. Glucocorticoids are corticosteroids that bind to the glucocorticoid receptor,[1] that is present in almost every vertebrate animal cell. The name “glucocorticoid” is a portmanteau (glucose + cortex + steroid) and is composed from its role in regulation of glucose metabolism, synthesis in the adrenal cortex, and its steroidal structure (see structure to the right). A less common synonym is glucocorticosteroid.

    Glucocorticoids are part of the feedback mechanism in the immune system which reduces certain aspects of immune function, such as inflammation. They are therefore used in medicine to treat diseases caused by an overactive immune system, such as allergies, asthma, autoimmune diseases, and sepsis. Glucocorticoids have many diverse (pleiotropic) effects, including potentially harmful side effects, and as a result are rarely sold over the counter.[2] They also interfere with some of the abnormal mechanisms in cancer cells, so they are used in high doses to treat cancer. This includes inhibitory effects on lymphocyte proliferation, as in the treatment of lymphomas and leukemias, and the mitigation of side effects of anticancer drugs.

    Glucocorticoids affect cells by binding to the glucocorticoid receptor. The activated glucocorticoid receptor-glucocorticoid complex up-regulates the expression of anti-inflammatory proteins in the nucleus (a process known as transactivation) and represses the expression of proinflammatory proteins in the cytosol by preventing the translocation of other transcription factors from the cytosol into the nucleus (transrepression).[2]

    Glucocorticoids are distinguished from mineralocorticoids and sex steroids by their specific receptors, target cells, and effects. In technical terms, “corticosteroid” refers to both glucocorticoids and mineralocorticoids (as both are mimics of hormones produced by the adrenal cortex), but is often used as a synonym for “glucocorticoid.” Glucocorticoids are chiefly produced in the zona fasciculata of the adrenal cortex, whereas mineralocorticoids are synthesized in the zona glomerulosa.

    Cortisol (or hydrocortisone) is the most important human glucocorticoid. It is essential for life, and it regulates or supports a variety of important cardiovascular, metabolic, immunologic, and homeostatic functions. Various synthetic glucocorticoids are available; these are widely utilized in general medical practice and numerous specialties either as replacement therapy in glucocorticoid deficiency or to suppress the immune system.

    Contents

    • 1 Effects
      • 1.1 Immune
      • 1.2 Metabolic
      • 1.3 Developmental
      • 1.4 Arousal and cognition
      • 1.5 Body fluid homeostasis
    • 2 Mechanism of action
      • 2.1 Transactivation
      • 2.2 Transrepression
      • 2.3 Nongenomic effects
    • 3 Pharmacology
    • 4 Therapeutic use
      • 4.1 Physiological replacement
      • 4.2 Therapeutic immunosuppression
      • 4.3 Anti-inflammatory
      • 4.4 Hyperaldosteronism
      • 4.5 Resistance
      • 4.6 Heart failure
    • 5 Side effects
      • 5.1 Immunodeficiency
      • 5.2 Withdrawal
    • 6 See also
    • 7 References
    • 8 External links

    Effects[edit]

    Steroidogenesis showing glucocorticoids in green ellipse at right with the primary example being cortisol.[3] It is not a strictly bounded group, but a continuum of structures with increasing glucocorticoid effect.

    Glucocorticoid effects may be broadly classified into two major categories: immunological and metabolic. In addition, glucocorticoids play important roles in fetal development and body fluid homeostasis.

    Immune[edit]

    As discussed in more detail below, glucocorticoids function through interaction with the glucocorticoid receptor:

    • up-regulate the expression of anti-inflammatory proteins.
    • down-regulate the expression of proinflammatory proteins.

    Glucocorticoids are also shown to play a role in the development and homeostasis of T lymphocytes. This has been shown in transgenic mice with either increased or decreased sensitivity of T cell lineage to glucocorticoids.[4]

    Metabolic[edit]

    The name “glucocorticoid” derives from early observations that these hormones were involved in glucose metabolism. In the fasted state, cortisol stimulates several processes that collectively serve to increase and maintain normal concentrations of glucose in blood.

    Metabolic effects:

    • Stimulation of gluconeogenesis, in particular, in the liver: This pathway results in the synthesis of glucose from non-hexose substrates, such as amino acids and glycerol from triglyceride breakdown, and is particularly important in carnivores and certain herbivores. Enhancing the expression of enzymes involved in gluconeogenesis is probably the best-known metabolic function of glucocorticoids.
    • Mobilization of amino acids from extrahepatic tissues: These serve as substrates for gluconeogenesis.
    • Inhibition of glucose uptake in muscle and adipose tissue: A mechanism to conserve glucose
    • Stimulation of fat breakdown in adipose tissue: The fatty acids released by lipolysis are used for production of energy in tissues like muscle, and the released glycerol provide another substrate for gluconeogenesis.

    Excessive glucocorticoid levels resulting from administration as a drug or hyperadrenocorticism have effects on many systems. Some examples include inhibition of bone formation, suppression of calcium absorption (both of which can lead to osteoporosis), delayed wound healing, muscle weakness, and increased risk of infection. These observations suggest a multitude of less-dramatic physiologic roles for glucocorticoids.[4]

    Developmental[edit]

    Glucocorticoids have multiple effects on fetal development. An important example is their role in promoting maturation of the lung and production of the surfactant necessary for extrauterine lung function. Mice with homozygous disruptions in the corticotropin-releasing hormone gene (see below) die at birth due to pulmonary immaturity. In addition, glucocorticoids are necessary for normal brain development, by initiating terminal maturation, remodeling axons and dendrites, and affecting cell survival[5] and may also play a role in hippocampal development. Glucocorticoids stimulate the maturation of the Na+/K+/ATPase, nutrient transporters, and digestion enzymes, promoting the development of a functioning gastro-intestinal system. Glucocorticoids also support the development of the neonate’s renal system by increasing glomerular filtration.

    Arousal and cognition[edit]

    A graphical representation of the Yerkes-Dodson curve

    Glucocorticoids act on the hippocampus, amygdala, and frontal lobes. Along with adrenaline, these enhance the formation of flashbulb memories of events associated with strong emotions, both positive and negative.[6] This has been confirmed in studies, whereby blockade of either glucocorticoids or noradrenaline activity impaired the recall of emotionally relevant information. Additional sources have shown subjects whose fear learning was accompanied by high cortisol levels had better consolidation of this memory (this effect was more important in men). The effect that glucocorticoids have on memory may be due to damage specifically to the CA1 area of the hippocampal formation. In multiple animal studies, prolonged stress (causing prolonged increases in glucocorticoid levels) have shown destruction of the neurons in this area of the brain, which has been connected to lower memory performance.[7][8][9]

    Glucocorticoids have also been shown to have a significant impact on vigilance (attention deficit disorder) and cognition (memory). This appears to follow the Yerkes-Dodson curve, as studies have shown circulating levels of glucocorticoids vs. memory performance follow an upside-down U pattern, much like the Yerkes-Dodson curve. For example, long-term potentiation (LTP; the process of forming long-term memories) is optimal when glucocorticoid levels are mildly elevated, whereas significant decreases of LTP are observed after adrenalectomy (low-glucocorticoid state) or after exogenous glucocorticoid administration (high-glucocorticoid state). Elevated levels of glucocorticoids enhance memory for emotionally arousing events, but lead more often than not to poor memory for material unrelated to the source of stress/emotional arousal.[10] In contrast to the dose-dependent enhancing effects of glucocorticoids on memory consolidation, these stress hormones have been shown to inhibit the retrieval of already stored information.[11] Long-term exposure to glucocorticoid medications, such as asthma and anti-inflammatory medication, has been shown to create deficits in memory and attention both during and, to a lesser extent, after treatment,[12][13] a condition known as “steroid dementia.”[14]

    Body fluid homeostasis[edit]

    Glucocorticoids could act centrally, as well as peripherally, to assist in the normalization of extracellular fluid volume by regulating body’s action to atrial natriuretic peptide (ANP). Centrally, glucocorticoids could inhibit dehydration induced water intake;[15] peripherally, glucocorticoids could induce a potent diuresis.[16]

    Mechanism of action[edit]

    Transactivation[edit]

    Glucocorticoids bind to the cytosolic glucocorticoid receptor, a type of nuclear receptor that is activated by ligand binding. After a hormone binds to the corresponding receptor, the newly formed complex translocates itself into the cell nucleus, where it binds to glucocorticoid response elements in the promoter region of the target genes resulting in the regulation of gene expression. This process is commonly referred to as transcriptional activation, or transactivation.[17][18]

    The proteins encoded by these up-regulated genes have a wide range of effects, including, for example:[18]

    • anti-inflammatory – lipocortin I, p11/calpactin binding protein, secretory leukocyte protease inhibitor 1 (SLPI), and Mitogen-activated protein kinase phosphatase (MAPK phosphatase)
    • increased gluconeogenesis – glucose-6-phosphatase and tyrosine aminotransferase

    Transrepression[edit]

    The opposite mechanism is called transcriptional repression, or transrepression. The classical understanding of this mechanism is that activated glucocorticoid receptor binds to DNA in the same site where another transcription factor would bind, which prevents the transcription of genes that are transcribed via the activity of that factor.[17][18] While this does occur, the results are not consistent for all cell types and conditions; there is no generally accepted, general mechanism for transrepression.[18]

    New mechanisms are being discovered where transcription is repressed, but the activated glucocorticoid receptor is not interacting with DNA, but rather with another transcription factor directly, thus interfering with it, or with other proteins that interfere with the function of other transcription factors. This latter mechanism appears to be the most likely way that activated glucocorticoid receptor interferes with NF-κB – namely by recruiting histone deacetylase, which deacetylate the DNA in the promoter region leading to closing of the chromatin structure where NF-κB needs to bind.[17][18]

    Nongenomic effects[edit]

    Activated glucocorticoid receptor has effects that have been experimentally shown to be independent of any effects on transcription and can only be due to direct binding of activated glucocorticoid receptor with other proteins or with mRNA.[17][18]

    For example, Src kinase which binds to inactive glucocorticoid receptor, is released when a glucocorticoid binds to glucocorticoid receptor, and phosphorylates a protein that in turn displaces an adaptor protein from a receptor important in inflammation, epidermal growth factor, reducing its activity, which in turn results in reduced creation of arachidonic acid – a key proinflammatory molecule. This is one mechanism by which glucocorticoids have an anti-inflammatory effect.[17]

    Pharmacology[edit]

    Dexamethasone – a synthetic glucocorticoid binds more powerfully to the glucocorticoid receptor than cortisol does. Dexamethasone is based on the cortisol structure but differs at three positions (extra double bond in the A-ring between carbons 1 and 2 and addition of a 9-α-fluoro group and a 16-α-methyl substituent).

    A variety of synthetic glucocorticoids, some far more potent than cortisol, have been created for therapeutic use. They differ in both pharmacokinetics (absorption factor, half-life, volume of distribution, clearance) and pharmacodynamics (for example the capacity of mineralocorticoid activity: retention of sodium (Na+) and water; renal physiology). Because they permeate the intestines easily, they are administered primarily per os (by mouth), but also by other methods, such as topically on skin. More than 90% of them bind different plasma proteins, though with a different binding specificity. Endogenous glucocorticoids and some synthetic corticoids have high affinity to the protein transcortin (also called corticosteroid-binding globulin), whereas all of them bind albumin. In the liver, they quickly metabolize by conjugation with a sulfate or glucuronic acid, and are secreted in the urine.

    Glucocorticoid potency, duration of effect, and the overlapping mineralocorticoid potency vary. Cortisol is the standard of comparison for glucocorticoid potency. Hydrocortisone is the name used for pharmaceutical preparations of cortisol.

    The data below refer to oral administration. Oral potency may be less than parenteral potency because significant amounts (up to 50% in some cases) may not reach the circulation. Fludrocortisone acetate and deoxycorticosterone acetate are, by definition, mineralocorticoids rather than glucocorticoids, but they do have minor glucocorticoid potency and are included in this table to provide perspective on mineralocorticoid potency.

    Therapeutic use[edit]

    Glucocorticoids may be used in low doses in adrenal insufficiency. In much higher doses, oral or inhaled glucocorticoids are used to suppress various allergic, inflammatory, and autoimmune disorders. Inhaled glucocorticoids are the second-line treatment for asthma. They are also administered as post-transplantory immunosuppressants to prevent the acute transplant rejection and the graft-versus-host disease. Nevertheless, they do not prevent an infection and also inhibit later reparative processes. Newly emerging evidence showed that glucocorticoids could be used in the treatment of heart failure to increase the renal responsiveness to diuretics and natriuretic peptides. Glucocorticoids are historically used for pain relief in inflammatory conditions.[20][21][22] However, corticosteroids show limited efficacy in pain relief and potential adverse events for their use in tendinopathies.[23]

    Physiological replacement[edit]

    Any glucocorticoid can be given in a dose that provides approximately the same glucocorticoid effects as normal cortisol production; this is referred to as physiologic, replacement, or maintenance dosing. This is approximately 6–12 mg/m²/day of hydrocortisone (m² refers to body surface area (BSA), and is a measure of body size; an average man’s BSA is 1.9 m²).

    Therapeutic immunosuppression[edit]

    See section on “Immunodeficiency” below for adverse effects

    Glucocorticoids cause immunosuppression, and the therapeutic component of this effect is mainly the decreases in the function and numbers of lymphocytes, including both B cells and T cells.

    The major mechanism for this immunosuppression is through inhibition of nuclear factor kappa-light-chain-enhancer of activated B cells(NF-κB). NF-κB is a critical transcription factor involved in the synthesis of many mediators (i.e., cytokines) and proteins (i.e., adhesion proteins) that promote the immune response. Inhibition of this transcription factor, therefore, blunts the capacity of the immune system to mount a response.[2]

    Glucocorticoids suppress cell-mediated immunity by inhibiting genes that code for the cytokines IL-1, IL-2, IL-3, IL-4, IL-5, IL-6, IL-8 and IFN-γ, the most important of which is IL-2. Smaller cytokine production reduces the T cell proliferation.[24]

    Glucocorticoids, however, not only reduce T cell proliferation, but also lead to another well known effect – glucocorticoid-induced apoptosis. The effect is more prominent in immature T cells still inside in the thymus, but peripheral T cells are also affected. The exact mechanism regulating this glucocorticoid sensitivity lies in the Bcl-2 gene.[25]

    Glucocorticoids also suppress the humoral immunity, thereby causing a humoral immune deficiency. Glucocorticoids cause B cells to express smaller amounts of IL-2 and of IL-2 receptors. This diminishes both B cell clone expansion and antibody synthesis. The diminished amounts of IL-2 also cause fewer T lymphocyte cells to be activated.

    The effect of glucocorticoids on Fc receptor expression in immune cells is complicated. Dexamethasone decreases IFN-gamma simulated Fc gamma RI expression in neutrophils while conversely causing an increase in monocytes.[26] Glucocorticoids may also decrease the expression of Fc receptors in macrophages,[27] but the evidence supporting this regulation in earlier studies has been questioned.[28] The effect of Fc receptor expression in macrophages is important since it is necessary for the phagocytosis of opsonised cells. This is because Fc receptors bind antibodies attached to cells targeted for destruction by macrophages.

    Anti-inflammatory[edit]

    Glucocorticoids are potent anti-inflammatories, regardless of the inflammation’s cause; their primary anti-inflammatory mechanism is lipocortin-1 (annexin-1) synthesis. Lipocortin-1 both suppresses phospholipase A2, thereby blocking eicosanoid production, and inhibits various leukocyte inflammatory events (epithelial adhesion, emigration, chemotaxis, phagocytosis, respiratory burst, etc.). In other words, glucocorticoids not only suppress immune response, but also inhibit the two main products of inflammation, prostaglandins and leukotrienes. They inhibit prostaglandin synthesis at the level of phospholipase A2 as well as at the level of cyclooxygenase/PGE isomerase (COX-1 and COX-2),[29] the latter effect being much like that of NSAIDs, potentiating the anti-inflammatory effect.

    In addition, glucocorticoids also suppress cyclooxygenase expression. [30]

    Glucocorticoids marketed as anti-inflammatories are often topical formulations, such as nasal sprays for rhinitis or inhalers for asthma. These preparations have the advantage of only affecting the targeted area, thereby reducing side effects or potential interactions. In this case, the main compounds used are beclometasone, budesonide, fluticasone, mometasone and ciclesonide. In rhinitis, sprays are used. For asthma, glucocorticoids are administered as inhalants with a metered-dose or dry powder inhaler.[31]

    Hyperaldosteronism[edit]

    Glucocorticoids can be used in the management of familial hyperaldosteronism type 1. They are not effective, however, for use in the type 2 condition.

    Resistance[edit]

    Corticosteroid resistance mechanisms

    Resistance to the therapeutic uses of glucocorticoids can present difficulty; for instance, 25% of cases of severe asthma may be unresponsive to steroids. This may be the result of genetic predisposition, ongoing exposure to the cause of the inflammation (such as allergens), immunological phenomena that bypass glucocorticoids, and pharmacokinetic disturbances (incomplete absorption or accelerated excretion or metabolism).[24]

    Heart failure[edit]

    Glucocorticoids could be used in the treatment of decompensated heart failure to potentiate renal responsiveness to diuretics, especially in heart failure patients with refractory diuretic resistance with large doses of loop diuretics.[32][33][34][35][36][37][38]

    Side effects[edit]

    Glucocorticoid drugs currently being used act nonselectively, so in the long run they may impair many healthy anabolic processes. To prevent this, much research has been focused recently on the elaboration of selectively acting glucocorticoid drugs. Side effects include:

    • Immunodeficiency (see section below)
    • Hyperglycemia due to increased gluconeogenesis, insulin resistance, and impaired glucose tolerance (“steroid diabetes”); caution in those with diabetes mellitus
    • Increased skin fragility, easy bruising
    • Negative calcium balance due to reduced intestinal calcium absorption[39]
    • Steroid-induced osteoporosis: reduced bone density (osteoporosis, osteonecrosis, higher fracture risk, slower fracture repair)
    • Weight gain due to increased visceral and truncal fat deposition (central obesity) and appetite stimulation
    • Hypercortisolemia with prolonged or excessive use (also known as, exogenous Cushing’s syndrome)
    • Impaired memory and attention deficits[40]
    • Adrenal insufficiency (if used for long time and stopped suddenly without a taper)
    • Muscle and tendon breakdown (proteolysis), weakness, reduced muscle mass and repair[41][23]
    • Expansion of malar fat pads and dilation of small blood vessels in skin
    • Lipomatosis within the epidural space[42]
    • Excitatory effect on central nervous system (euphoria, psychosis)
    • Anovulation, irregularity of menstrual periods
    • Growth failure, delayed puberty
    • Increased plasma amino acids, increased urea formation, negative nitrogen balance
    • Glaucoma due to increased ocular pressure
    • Cataracts
    • Topical steroid addiction

    In high doses, hydrocortisone (cortisol) and those glucocorticoids with appreciable mineralocorticoid potency can exert a mineralocorticoid effect as well, although in physiologic doses this is prevented by rapid degradation of cortisol by 11β-hydroxysteroid dehydrogenase isoenzyme 2 (11β-HSD2) in mineralocorticoid target tissues. Mineralocorticoid effects can include salt and water retention, extracellular fluid volume expansion, hypertension, potassium depletion, and metabolic alkalosis.

    Immunodeficiency[edit]

    Glucocorticoids cause immunosuppression, decreasing the function and/or numbers of neutrophils, lymphocytes (including both B cells and T cells), monocytes, macrophages, and the anatomical barrier function of the skin.[43] This suppression, if large enough, can cause manifestations of immunodeficiency, including T cell deficiency, humoral immune deficiency and neutropenia.

    Withdrawal[edit]

    In addition to the effects listed above, use of high-dose steroids for more than a week begins to produce suppression of the patient’s adrenal glands because the exogenous glucocorticoids suppress hypothalamic corticotropin-releasing hormone and pituitary adrenocorticotropic hormone. With prolonged suppression, the adrenal glands atrophy (physically shrink), and can take months to recover full function after discontinuation of the exogenous glucocorticoid.

    During this recovery time, the patient is vulnerable to adrenal insufficiency during times of stress, such as illness. While suppressive dose and time for adrenal recovery vary widely, clinical guidelines have been devised to estimate potential adrenal suppression and recovery, to reduce risk to the patient. The following is one example:

    • If patients have been receiving daily high doses for five days or less, they can be abruptly stopped (or reduced to physiologic replacement if patients are adrenal-deficient). Full adrenal recovery can be assumed to occur by a week afterward.
    • If high doses were used for six to 10 days, reduce to replacement dose immediately and taper over four more days. Adrenal recovery can be assumed to occur within two to four weeks of completion of steroids.
    • If high doses were used for 11–30 days, cut immediately to twice replacement, and then by 25% every four days. Stop entirely when dose is less than half of replacement. Full adrenal recovery should occur within one to three months of completion of withdrawal.
    • If high doses were used more than 30 days, cut dose immediately to twice replacement, and reduce by 25% each week until replacement is reached. Then change to oral hydrocortisone or cortisone as a single morning dose, and gradually decrease by 2.5 mg each week. When the morning dose is less than replacement, the return of normal basal adrenal function may be documented by checking 0800 cortisol levels prior to the morning dose; stop drugs when 0800 cortisol is 10 μg/dl. Predicting the time to full adrenal recovery after prolonged suppressive exogenous steroids is difficult; some people may take nearly a year.
    • Flare-up of the underlying condition for which steroids are given may require a more gradual taper than outlined above.

    See also[edit]

    • List of corticosteroids
    • List of corticosteroid cyclic ketals
    • List of corticosteroid esters
    • Aminoglutethimide blocks glucocorticoid secretion
    • GITR (glucocorticoid-induced TNF receptor)
    • Glucocorticoid receptor
    • Immunosuppressive drug
    • Membrane glucocorticoid receptor
    • Metyrapone blocks glucocorticoid secretion
    • Selective glucocorticoid receptor agonist
    • Topical steroid
    • Steroid atrophy
    • Topical steroid withdrawal
    • Non-steroidal anti-inflammatory drug (NSAID)

    References[edit]

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  • ^ Gelber JD (January 2017). “CORR Insights: Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis”. Clinical Orthopaedics and Related Research. 475 (1): 244–246. doi:10.1007/s11999-016-5044-4. PMC 5174046 . PMID 27572298. 
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  • ^ a b Klein NC, Go CH, Cunha BA (Jun 2001). “Infections associated with steroid use”. Infectious Disease Clinics of North America. 15 (2): 423–32, viii. doi:10.1016/s0891-5520(05)70154-9. PMID 11447704. 
  • External links[edit]

    • Glucocorticoids at the US National Library of Medicine Medical Subject Headings (MeSH)
    • Bowen R (2006-05-26). “Glucocorticoids”. Colorado State University. Retrieved 2008-05-11. 
    • Wolkowitz OM, Burke H, Epel ES, Reus VI (Oct 2009). “Glucocorticoids. Mood, memory, and mechanisms”. Annals of the New York Academy of Sciences. 1179: 19–40. doi:10.1111/j.1749-6632.2009.04980.x. PMID 19906230. 
    • “Introduction + Classification + Pharmacological Action + Regulation of Release and Drawback of Glucocorticoids Hormone”. 

    Antiglucocorticoids

    • Antagonists: Aglepristone
    • Ketoconazole
    • Mifepristone
    • Ulipristal acetate

    Synthesis modifiers

    • Acetoxolone
    • Aminoglutethimide
    • Carbenoxolone
    • Enoxolone
    • Ketoconazole
    • Metyrapone
    • Mitotane
    • Trilostane
    • #WHO-EM
    • ‡Withdrawn from market
    • Clinical trials:
      • †Phase III
      • §Never to phase III

    See also
    Glucocorticoid receptor modulators
    Mineralocorticoids and antimineralocorticoids
    List of corticosteroids

    See also
    Receptor/signaling modulators
    Glucocorticoids and antiglucocorticoids
    Mineralocorticoid receptor modulators
    List of corticosteroids


    Source: https://en.wikipedia.org/wiki/Glucocorticoid

    One of the Most Overlooked Systems for Prednisone For Poison Ivy

    Prednisone is made by dehydrogenation of cortisone. It needs to be discontinued gradually. It is a type of steroid, which provides the body with the extra glucocorticoids, which it needs to overcome the inflammations and other health conditions that the body might be suffering from. It is a popular drug recommended by doctors for treating a wide range of medical conditions. It is primarily a steroid and so, it does have both positive as well as negative effects on our health. In short, it must not be taken without the prescription of a doctor. It is a type of steroid that helps restore immunity levels, which malfunction as a result of illness or injury.

    You may see a rash develop in as few as eight to two days. The rash is typically a line or a cluster. Doing this will get the rash to spread. Allergic rashes may also be brought on by common allergies and environmental irritants. Sometimes they can be caused by autoimmune disorders such as lupus and scleroderma. They usually have triggers that become recognizable after the first few outbreaks. Allergic skin rashes may also develop as a consequence of fungal infections in addition to, infections brought on by bacteria and fungus.

    Prednisone treatment cannot be stopped abruptly. Generally, it begins with a high dose which is gradually reduced over a period of few weeks. Getting treatment for poison ivy will produce the patient comfortable in addition to reduce the likelihood of skin infection. Poison ivy treatments are usually restricted to self-care strategies.

    Your health care provider may monitor the consequences of prednisone withdrawal on your entire body and suggest you to adhere to a specific procedure such as gradual decline in prednisone dosages by certain amount, altering your diet plan and suggesting you to do a few exercises. For a complete body rash, the physician can suggest two or three things. Only a health care provider would have the capacity to determine the suitable plan of treatment. In the event the doctor believes you have the rash, there are many things he or she is able to prescribe or recommend for you. Make certain you seek advice from your health care provider before giving your child prednisone, since the dosage varies in line with the essence of the ailment. Also, list questions you want to ask your physician about your poison ivy rash.

    You may need to decrease your dosage slowly before stopping it. The dosage could be higher for serious conditions like asthma or nephrotic syndrome. The dosage of the drug must be increased, or a different corticosteroid drug should be prescribed to control the signs of the status. It needs to be tapered to avoid side effects after discontinuing use, and the entire course should be taken since stopping earlier may result in a rebound rash as bad as the original. Hence, it ought to be mentioned that before beginning to take prednisone dosage, or making any type of modifications to the present dosage, taking an opinion of your physician is extremely important. An individual should always comply with the prescribed dosage of prednisone as a way to attain the best outcomes.

    Make certain you do not miss any dose. If In the event you do miss a dose, take it whenever possible. The doses would need to be increased for a brief period followed by gradual decrease in dosage. Lowering the dose of prednisone gradually aids the adrenal glands to recuperate slowly. It is often adjusted taking into consideration the response to the therapy. Needless to say, the suggested dose for kids is lower.

    As stated above, prednisone is among the most productive drugs offered in the sector and used for the treatment of autoimmune disorders. Along with weight gain, it can cause osteoporosis by accelerating the process of bone loss. It is one of the most effective drugs available in the market today. Prednisone might also be prescribed to individuals who have to undergo imaging strategies, like CT scan, that involve using intravenous dyes.

    Prednisone can on occasion be affiliated with certain kinds of side results. It belongs to the family of corticosteroid drugs, and is similar to the hormone cortisol produced by the adrenal glands. It comes under the category of drugs called corticosteroids. It is one of the most commonly prescribed synthetic glucocorticoid drugs. At the same time, it is one of the crucial drugs used in treatment of certain types of cancer like the non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, etc.. The synthetic hormone prednisone is utilized to take care of numerous ailments.

    In the event the steroid is provided for an extremely brief time period, then tapering might not be required before stopping. An individual must also spend the steroid according to the suggested dosage and take it until the time that’s been suggested by the physician. Typically, steroids are prescribed while the use of different drugs aren’t giving the desired outcomes. The drug needs to be taken under medical supervision. To prevent adverse effects, one ought to select the drug in the prescribed dosage. Anyway, consuming alcohol together with prednisone also is dependent on your general well-being and tolerance levels.

    Who is Concerned About Prednisone Steroid and Why You Should be Listening to Them

    Prednisone comes under the class of drugs called corticosteroids. It may be prescribed along with other medications like analgesics and muscle relaxants depending on the severity of the disorder. It mimics the effects of cortisol by reducing the amount of inflammation in the TMJ joints. You fear taking Prednisone or any other type of medicine for Psoriasis.

    Steroids might be administered in pill form, or they are sometimes injected into your joint. From time to time, they work for a person, and sometimes they don’t. They are not healthy for you in general and can cause a plethora of side effects and even death in some cases. They can also be used as a pain reliever in some cases, but mostly they are used to give a look of strength because they promote growth of tissues and muscles to give men and some women the larger muscles that they are looking for. They are expensive though, and many men cannot keep up with the cost to see if their penis actually gets larger because of it. Despite the fact that they have been banned by every major sport and even high school sports, people are still using steroids. Anabolic steroids are the most frequent steroids used.

    Most Noticeable Prednisone Steroid

    The impacts of steroids don’t just stop at damaging the body, but they are able to make a guy to turn into impotent either temporarily or permanently. Side effects of steroids could include thinning bones, bad wound healing and a decreased capacity to resist infection. The side effects can be severe, hence it is preferable to avert the consumption altogether. Potential side effects change from person to person. There are potential side effects with Prednisone usage.

    Once more, always ask your physician to figure out if it’s secure or not. Doctors advise their patients not to consume alcohol, particularly in the very first phase of therapy once the potential side effects of prednisone have to get understood. Doctors who prescribe prednisone for unrelated health conditions may not anticipate that you’ve got an undiagnosed case of diverticulosis.

    If you get a diagnosis of diverticulosis, your doctor reviews strategies like dietary modifications to help you stay away from infection. Disease is a bit harsh. Kidney diseases are listed in the class of common and life threatening diseases. The differential diagnosis of PMR consists of early seronegative rheumatoid arthritis and a selection of different disorders that could typically be easily distinguished from PMR. Anyway, if your symptoms have ceased, it’s no indication you could start the use of alcohol all over again. It is crucial to understand which often-prescribed medications can worsen the signs of diverticulitis, and when they ought to be avoided. Severe joint pain is a significant and almost universal complaint experienced by many folks taking Prednisone, due probably to how it steals the human body’s natural calcium necessary to maintain healthier and inflammation free joints.

    If you’re taking drugs containing steroids, you could be retaining water. If you take medication containing steroids, ask your physician if there’s a steroid-free substitute. It is very important to know which medications may be used together, to steer clear of serious adverse reactions or even death. In all circumstances, you’re advised to prevent steroid medications like prednisone.

    To be safe, it’s advised to select the medicine that’s been prescribed only and never to use the counter medication. Certain medicines may also trigger gout, like diuretics, niacin, low doses of aspirin, cyclosporine and a few drugs used in the treatment of cancer. Not all medicines will begin to work at the exact same moment. Medicines in the circulatory system regardless of what form a medicine takes they’ll be dissolved and enter the blood stream sooner or later. The explanations for why you’ve been given the medication in the very first place also must be considered.

    The Fundamentals of Prednisone Steroid Revealed

    Inhaled corticosteroids work because the medication is delivered right to the lung. Further, it’s been demonstrated that a single dose of particular corticosteroids will create adrenocortical suppression for a few days. Oral corticosteroid like Prednisone can be prescribed.

    The Upside to Prednisone Steroid

    Prednisone is a strong corticosteroid with a greater chance of side effects than Tylenol. It can also present problems for people with asymptomatic diverticulosis. It is a type of medication that is termed a steroid. It is a prodrug that is converted by the liver into prednisolone, which is the active drug and also a steroid. It may cause a dangerous increase in blood pressure which may cause symptoms including seizures and could result in a sudden heart attack. It is a steroid and it is also known as corticosteroid and it is useful in treating different disease but it has to be done under the surveillance of experts and doctors. Employing prednisone during an active case of diverticulitis might increase the harshness of the illness.