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endocrine:drugs:fluticasone [2026/02/12 19:38] – created andrew2393cnsendocrine:drugs:fluticasone [2026/02/12 20:04] (current) – created andrew2393cns
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-====== Corticosteroids ====== +====== Fluticasone ======
- +
-Corticosteroids are synthetic analogs of adrenal cortex hormones used for their potent anti-inflammatory and immunosuppressive effects. +
- +
-They mimic: +
-  * Cortisol (glucocorticoid activity) +
-  * Aldosterone (mineralocorticoid activity – some agents) +
- +
-Used across systems: +
-  * [[allergy:clinical:allergic_rhinitis|Allergic Rhinitis]] +
-  * [[allergy:clinical:urticaria_angioedema|Urticaria]] +
-  * Asthma +
-  * Autoimmune disease +
-  * Dermatologic conditions +
-  * Transplant medicine +
- +
-----+
  
 ===== Classification ===== ===== Classification =====
 +  * High-potency inhaled/intranasal glucocorticoid
  
-==== Systemic Glucocorticoids ==== +Parent class: 
-  * [[endocrine:drugs:prednisone|Prednisone]] +  * [[endocrine:drug_classes:corticosteroids|Corticosteroids]]
-  * [[endocrine:drugs:prednisolone|Prednisolone]] +
-  * [[endocrine:drugs:methylprednisolone|Methylprednisolone]] +
-  * [[endocrine:drugs:dexamethasone|Dexamethasone]] +
-  * [[endocrine:drugs:hydrocortisone|Hydrocortisone]] +
- +
-==== Inhaled / Intranasal ==== +
-  * [[endocrine:drugs:fluticasone|Fluticasone]] +
-  * [[endocrine:drugs:budesonide|Budesonide]] +
-  * [[endocrine:drugs:mometasone|Mometasone]] +
-  * [[endocrine:drugs:triamcinolone|Triamcinolone]] +
- +
-==== Topical ==== +
-  * Various potency classes+
  
 ---- ----
  
-===== Mechanism of Action =====+===== Clinical Uses =====
  
-Corticosteroids act via intracellular glucocorticoid receptors. +  * [[respiratory:clinical:asthma|Asthma]] 
- +  * [[allergy:clinical:allergic_rhinitis|Allergic Rhinitis]]
-Stepwise: +
- +
-  1) Drug diffuses across cell membrane +
-  2) Binds cytoplasmic glucocorticoid receptor +
-  3) Complex translocates to nucleus +
-  4) Alters gene transcription +
- +
-Results: +
- +
-  * ↓ Pro-inflammatory cytokines (IL-1, IL-2, IL-4, IL-5, IL-6, TNF-α) +
-  * ↓ Eosinophil survival +
-  * ↓ T-cell activation +
-  * ↓ Mast cell mediator release +
-  * ↓ Prostaglandin synthesis (via ↓ phospholipase A2) +
-  * ↓ Leukotriene production +
- +
-Effect: +
-  Broad suppression of inflammation. +
- +
-Onset: +
-  * Hours to days (genomic mechanism) +
- +
----- +
- +
-===== Glucocorticoid vs Mineralocorticoid Activity ===== +
- +
-^ Drug ^ Glucocorticoid Potency ^ Mineralocorticoid Activity ^ +
-| Hydrocortisone | Low | Moderate | +
-| Prednisone | Moderate | Low | +
-| Methylprednisolone | Moderate | Minimal | +
-| Dexamethasone | High | None | +
- +
-Clinical relevance: +
-  * Mineralocorticoid activity → fluid retention, hypertension +
-  * Dexamethasone preferred when fluid retention undesirable +
- +
----- +
- +
-===== Indications (Allergy Context) ===== +
- +
-Type I hypersensitivity late-phase control: +
-  * [[allergy:immunology:type_i_hypersensitivity|Late Phase Reaction]] +
- +
-Allergic rhinitis: +
-  * Intranasal first-line +
- +
-Asthma: +
-  * Inhaled maintenance therapy +
- +
-Severe allergic reactions: +
-  * Adjunct in anaphylaxis (not first-line) +
- +
-Autoimmune and inflammatory disease: +
-  * Broad use +
- +
----- +
- +
-===== Adverse Effects ===== +
- +
-Short-term: +
-  * Mood changes +
-  * Hyperglycemia +
-  * Fluid retention +
-  * Insomnia +
- +
-Long-term: +
-  * Adrenal suppression +
-  * Osteoporosis +
-  * Cushingoid appearance +
-  * Muscle wasting +
-  * Increased infection risk +
-  * Peptic ulcer disease +
- +
-Mechanism: +
-  Systemic immunosuppression and metabolic alteration. +
- +
----- +
- +
-===== Hypothalamic–Pituitary–Adrenal (HPA) Axis Suppression ===== +
- +
-Chronic steroid use suppresses endogenous cortisol production. +
- +
-Abrupt withdrawal may cause: +
-  * Adrenal insufficiency +
-  * Hypotension +
-  * Fatigue +
-  * Crisis in severe cases +
- +
-Taper when: +
-  * High dose +
-  * Prolonged use (>2–3 weeks)+
  
 ---- ----
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 ===== Clinical Pearls ===== ===== Clinical Pearls =====
  
-  * Intranasal corticosteroids are superior to oral antihistamines for nasal congestion. +  * Minimal systemic absorption when inhaled. 
-  * Steroids suppress late-phase allergic inflammation. +  * First-line for allergic rhinitis congestion.
-  * Dexamethasone has no mineralocorticoid activity. +
-  * Always consider HPA suppression with prolonged systemic therapy. +
-  * In anaphylaxis, epinephrine is first-line — steroids are adjunctive. +
- +
----- +
- +
-===== Related Pages ===== +
- +
-  * [[allergy:histamine|Histamine & Antihistamines]] +
-  * [[allergy:immunology:type_i_hypersensitivity|Type I Hypersensitivity]] +
-  * [[cardio:drugs:epinephrine|Epinephrine]]+
endocrine/drugs/fluticasone.1770925111.txt.gz · Last modified: by andrew2393cns