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endocrine:drugs:fluticasone [2026/02/12 19:40] – 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 potent anti-inflammatory and immunosuppressive effects. +
- +
-They mimic: +
-  * Cortisol (glucocorticoid activity) +
-  * Aldosterone (mineralocorticoid activity — varies by agent) +
- +
-This page focuses on pharmacology.   +
-For disease-specific management, see linked clinical pages below. +
- +
-----+
  
 ===== Classification ===== ===== Classification =====
 +  * High-potency inhaled/intranasal glucocorticoid
  
-==== Systemic Glucocorticoids ==== +Parent class: 
-  * [[endocrine:drugs:hydrocortisone|Hydrocortisone]] +  * [[endocrine:drug_classes:corticosteroids|Corticosteroids]]
-  * [[endocrine:drugs:prednisone|Prednisone]] +
-  * [[endocrine:drugs:prednisolone|Prednisolone]] +
-  * [[endocrine:drugs:methylprednisolone|Methylprednisolone]] +
-  * [[endocrine:drugs:dexamethasone|Dexamethasone]] +
- +
-==== Inhaled / Intranasal ==== +
-  * [[endocrine:drugs:fluticasone|Fluticasone]] +
-  * [[endocrine:drugs:budesonide|Budesonide]] +
-  * [[endocrine:drugs:mometasone|Mometasone]] +
-  * [[endocrine:drugs:triamcinolone|Triamcinolone]] +
- +
-==== Topical ==== +
-  * Multiple potency classes (dermatologic use)+
  
 ---- ----
  
-===== Mechanism of Action ===== +===== Clinical Uses =====
- +
-Corticosteroids act via intracellular glucocorticoid receptors. +
- +
-Stepwise: +
- +
-  1) Drug diffuses across cell membrane +
-  2) Binds cytoplasmic glucocorticoid receptor +
-  3) Complex translocates to nucleus +
-  4) Alters gene transcription +
- +
-Primary effects: +
- +
-  * ↓ IL-1, IL-2, IL-4, IL-5, IL-6, TNF-α +
-  * ↓ Eosinophil survival +
-  * ↓ T-cell activation +
-  * ↓ Mast cell mediator release +
-  * ↓ Phospholipase A2 → ↓ prostaglandins & leukotrienes +
- +
-Result: +
-  Broad suppression of inflammatory pathways. +
- +
-Onset: +
-  * Hours to days (genomic effect) +
- +
----- +
- +
-===== Glucocorticoid vs Mineralocorticoid Activity ===== +
- +
-^ Drug ^ Glucocorticoid Potency ^ Mineralocorticoid Activity ^ +
-| Hydrocortisone | Low | Moderate | +
-| Prednisone | Moderate | Low | +
-| Methylprednisolone | Moderate | Minimal | +
-| Dexamethasone | High | None | +
- +
-Clinical implications: +
- +
-  * Mineralocorticoid activity → fluid retention, edema, hypertension +
-  * Dexamethasone preferred when fluid retention undesirable +
- +
----- +
- +
-===== Pharmacologic Roles Across Systems ===== +
- +
-Corticosteroids are used in many disease states:+
  
 +  * [[respiratory:clinical:asthma|Asthma]]
   * [[allergy:clinical:allergic_rhinitis|Allergic Rhinitis]]   * [[allergy:clinical:allergic_rhinitis|Allergic Rhinitis]]
-  * [[respiratory:clinical:asthma|Asthma]] 
-  * [[dermatology:clinical:atopic_dermatitis|Atopic Dermatitis]] 
-  * [[rheumatology:clinical:rheumatoid_arthritis|Rheumatoid Arthritis]] 
-  * [[gastroenterology:clinical:ibd|Inflammatory Bowel Disease]] 
-  * [[allergy:clinical:anaphylaxis|Anaphylaxis]] (adjunct therapy) 
-  * Transplant rejection prevention 
- 
-This reflects their broad anti-inflammatory and immunosuppressive activity. 
- 
----- 
- 
-===== Adverse Effects ===== 
- 
-Short-term: 
-  * Hyperglycemia 
-  * Mood changes 
-  * Fluid retention 
-  * Insomnia 
-  * Increased appetite 
- 
-Long-term: 
-  * Adrenal suppression 
-  * Osteoporosis 
-  * Cushingoid features 
-  * Muscle wasting 
-  * Increased infection risk 
-  * Peptic ulcer disease 
-  * Skin thinning 
- 
-Mechanism: 
-  Systemic metabolic and immune suppression. 
- 
----- 
- 
-===== HPA Axis Suppression ===== 
- 
-Chronic systemic corticosteroid use suppresses endogenous cortisol production. 
- 
-Abrupt discontinuation may cause: 
- 
-  * Adrenal insufficiency 
-  * Hypotension 
-  * Fatigue 
-  * Adrenal crisis (severe cases) 
- 
-Taper required when: 
-  * Therapy > 2–3 weeks 
-  * Moderate to high doses 
-  * Cushingoid features present 
  
 ---- ----
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 ===== Clinical Pearls ===== ===== Clinical Pearls =====
  
-  * Intranasal corticosteroids are first-line for nasal congestion in allergic rhinitis. +  * Minimal systemic absorption when inhaled. 
-  * Inhaled corticosteroids are foundational in asthma management. +  * First-line for allergic rhinitis congestion.
-  * Steroids suppress late-phase allergic inflammation. +
-  * Epinephrine, not steroids, is first-line in anaphylaxis. +
-  * Always consider HPA suppression in prolonged systemic therapy. +
- +
----- +
- +
-===== Related Pages ===== +
- +
-  * [[allergy:histamine|Histamine & Antihistamines]] +
-  * [[allergy:immunology:type_i_hypersensitivity|Type I Hypersensitivity]] +
-  * [[autonomics:adrenergic_agonists:epinephrine|Epinephrine]]+
endocrine/drugs/fluticasone.1770925229.txt.gz · Last modified: by andrew2393cns