Corticoids friends or enemies

CORTICOIDS: FRIENDS OR ENEMIES?

In the veterinary medicine of small animals the diseases are numerous that can be controlled by means of the short and/or long term administration to of corticoids, these diseases have one generally patogenia immune. The corticoids have many beneficial effects as well as many adverse effects, the balance between costs and benefits will determine the necessity to use them or to discard them: friends or enemies?

What farmacológicas actions have?

The corticosteroides have 4 farmacológicas actions:

* Intermediary metabolism.
* Catabolism.
* Inflammatory answer.
* Immune response.

When they are used?

1. - Diseases endócrinas (substitution therapy):
* Acute suprarrenal insufficiency (high doses of corticoids via endovenosa)
* Chronic suprarrenal insufficiency.
* Congenital suprarrenal Hiperplasia.

2. - Diseases nonendócrinas:
* Anaphylactic shock: they must be administered by a short period.
* Diseases autoinmunes: the autoimmunity, very numerous group of diseases, in which, the therapeutic objective is to depress the immune response that is affecting the organism (allergies, THEM, reumatoídea arthritis, etc?).
* Hematológicas diseases autoinmunes: idiopático trombocitopenico purple, hemolítica anemia.
* Cerebral Edema: that produced by a tumorlike mass has good answer.
* Tumors: leukemia, linfomas
* Active chronic hepatitis.
* Etc?.

Its greater Veterinary Medicine use is to try to obtain a inmunosupresión in different dermopatías (diseases of the skin) since, the glucocorticoids are antinflamatorios inespecíficos, act as opposed to anyone noxa (cause) of inflammation is physical, chemical, biological and immunological.
In dermatology mainly by means of the corticoids one is to obtain a farmacológico control of the prurito (picazón) canine and feline.
In dogs, safe in the allergy to foods, the corticoids work very well, although their indirect effect in the long term induce to look for alternatives, which are not so effective, which forces to make tests in each patient.
On the contrary, in cats, the antihistamine use of H1 (noncorticoidea therapy) allows an suitable control of the prurito, with few indirect effect thus the corticoids are not used so much in dermopatias. The felines have greater resistance to the corticoids which allows the long term use of slowed down forms parenterales, which frequently thanks for the owner due to the resistance which they present/display certain gatunos individuals to the administration via oral of medicines.

What indirect effect have?
The corticoids, as it is known, have little adverse effects in treatments of short term but numerous and intense indirect effect when they are used in the long term, emphasizing the appearance of the syndrome of iatrogénico Cushing who, although is more probable to observe it when slowed down injectable forms of repeated way are used.
The main signs that appear are:
* Poliuria (much tinkles)
* Polidipsia (much thirst)
* Polifagia (much hunger)
* Cushingoide aspect: with abdomen pendulum, alopecia (lack of hair) bilateral
* Greater susceptibility to infections
* Others: Gastric ulcers, diabetes, hepatopatías, etc?

When the veterinarians decide to indicate a treatment with a glucocorticoid become several questions, to see if it is a benefit and not a risk for the patient, if is justified, as it is the minimum dose, etc? and will consider each one of the risk factors (gastropatía, ulcer)
In cats the use of long term corticoids much less raises intense indirect effect that in dogs, which even allows the use of slowed down parenterales formulations, avoiding ?annoying? the daily administration of oral forms.

This classification as far as power, this power is proportional to the indirect effect of such:

How and in what dose they are possible to be administered?
In general the doses of glucocorticoids will depend on the type of corticoid, the pathology, the gravity of the disease, each individual in individual and tolerance to such. The dosage will be respecting the circadian rythm of each species in individual: (the circadian rythm is the rate that has the suprarrenal gland for the secretion of the glucocorticoids that is variable during the day). To administer in alternating days in chronic therapies is fundamental to diminish the indirect effect, in this way the blockade of the axis is prevented and many of the indirect effect before mentioned will be avoided.

Author: MV Adelaida A. Goldman