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Natural corticosteroid
◦ cortisol (hydrocortisone)
Syntetic corticosteroid
◦ glucocortikoid
Kortex adrenal menghasilkan steroid
◦ Glukorkortikoid: yg terpenting
kortisol/hidrokortison
◦ Mineralokortikoid: yg terpenting aldosteron
Setiap hari dlm keadaan tdk stress disintesis
kortisol 10-20 mg of cortisol
90% kortisol terikat globulin (CBG:
corticosteroid binding globulin)
T1/2nya 60-90 menit
20% of cortisol is converted to cortisone by
11-hydroxysteroid dehydrogenase in the
kidney
Efek metabolik
◦ Meningkatkan kadar glukosa darahshg
Menstimuli insulinmenghambat uptake glukosa
oleh sel otot
Catabolik n anabolic
◦ Penuruan massa otot, kelahan dan penipisan kulit
◦ Menyebabkan osteoporosis (pd cusshing syndrome)
◦ Pada anak menghambat pertumbuhan
Antiinflamasi
◦ Memiliki efek supresi terhadap sitokin inflamasi,
kemokin, dan mediator inflamasi lain
◦ Menhmabat fungsi makrofag jaringan dan antigen
precenting cell yang lain
◦ Menurunkan mediator inflamasi spt PG, leukotrin dan
PAF
◦ Menyebabka vasokonstriksi ketika diberika n ke kulit
langsung karena supresi mast cell degranulasi
◦ Menurunkan permiabilitas capiler dg cara penurunan
jumlah histamin yang dilepaskan basofil dan mast cell
◦ Pada dosis besar menurunkan jumlah produksi antibodi
..
Indikasi:
◦ Antiinflamsi
◦ Ati alergi
◦ Pengobatan ggn fungsi adrenal
◦ Menstimuli maturasi paru fetus
◦ Asma
◦ Remathoid disease
◦ imunosupresive
Toksisitas
◦ Metabolic effect:pasien yang diberikan dosis harian
>100 mg hidrokortison selama > 2
mingguMengalami iatrogenik Cushing. Dg gejala
moon face, buffalo hump, lemak cenderung
didistribusikantubuh, bagian belakang leher, dan
fosa supraklavikula. Ada pertumbuhan meningkat
dari rambut halus pada wajah, paha dan badan. Bisa
muncul Steroid-induced puctata acne, insomnia
dan meningkatkan nafsu makan.
◦ Ulkus peptic
◦ Supresi adrenalpe,berian>2 minggu
Kontraindikasi:
◦ peptic ulcer,
◦ heart disease or hypertension with heart failure,
◦ certain infectious illnesses such as varicella and
tuberculosis,
◦ psychoses, diabetes, osteoporosis, or glaucoma.
◦ systemic infection (unless specific antimicrobial
therapy given);
gastro-intestinal effects include dyspepsia,
peptic ulceration (with perforation), abdominal
distension, acute pancreatitis, oesophageal
ulceration and candidiasis;
musculoskeletal effects include proximal
myopathy, osteoporosis, vertebral and long bone
fractures, avascular osteonecrosis, tendon
rupture;
endocrine effects include adrenal suppression,
menstrual irregularities and amenorrhoea,
Cushing's syndrome (with high doses, usually
reversible on withdrawal),
hirsutism, weight gain, negative nitrogen and
calcium balance, increased appetite;
increased susceptibility to and severity of
infection;
◦ neuropsychiatric effects include psychological
dependence, increased intracranial pressure with
papilloedema in children (usually after withdrawal),
aggravation of schizophrenia, aggravation of
epilepsy
◦ ophthalmic effects include glaucoma, papilloedema,
posterior subcapsular cataracts, corneal or scleral
thinning and exacerbation of ophthalmic viral or
fungal disease;
◦ other side-effects include impaired healing, skin
atrophy, bruising, striae, telangiectasia, acne,
myocardial rupture following recent myocardial
infarction, fluid and electrolyte disturbance,
leucocytosis, hypersensitivity reactions (including
anaphylaxis), thromboembolism, nausea, malaise,
hiccups