How to avoid excessive intake of glucocorticoids

Glucocorticoid abuse can lead to an increase in adverse reactions, aggravation or spread of infection, increase the difficulty of diagnosis and development of many diseases, and even endanger the life of patients.

The irrational use of glucocorticoids is manifested in many aspects: no indication for drugs, over-range, over-dose, over-course of drugs, etc., and there are also cases where the dose of drugs is insufficient for the course of treatment, which affects the clinical efficacy. How to standardize the application of glucocorticoids, give full play to their best effects, and avoid and reduce the occurrence of adverse events are prominent problems that need to be solved at present.

Contraindications to glucocorticoids: previous or present severe psychosis and epilepsy, active peptic ulcer disease, recent gastrointestinal anastomosis surgery, fractures, trauma repair, corneal ulcers, adrenal hyperactivity, severe hypertension, diabetes, pregnant women, infections that cannot be controlled by antimicrobial drugs such as chickenpox, fungal infections, etc.

Principle: Because it can improve the excitability of the central ganglion system, it can occasionally induce mental disorders.

It can increase the secretion of gastric acid and pepsin, induce or aggravate ulcer disease. It can promote protein decomposition, inhibit its synthesis and increase calcium and phosphorus excretion, resulting in osteoporosis and slow wound healing.

Because it is a kind of adrenocorticosteroid used in large quantities for a long time, it is easy to cause adrenocortical hyperfunction syndrome.

Long-term use can cause hypertension and atherosclerosis.

It can reduce the utilization of glucose by body tissues and raise blood sugar.

It can cause teratogenesis in pregnant women.

It will reduce the body's defense ability, and aggravate the virus infection.

Glucocorticoids have a wide range of effects, and all its effects can be summarized as one advance and one retreat, two less and three more, four antibodies and five metabolisms in medicine. A common adverse reaction is that patients will have a full moon face and central obesity, and it will promote gastric acid secretion, which may lead to the occurrence of gastric ulcers.

When it comes to absolute contraindications, I summarize it into two points, the first point is that in the absence of drugs, anti-inflammatory with glucocorticoids will aggravate the infection. The second point is that the drug should never be stopped immediately, because long-term use of glucocorticoids will cause the human adrenal cortex to atrophy and reduce ACTH secretion. Otherwise, symptoms may worsen.

1. Adverse reactions caused by long-term large-scale application.

1) Hypercortical syndrome. Full moon face, buffalo back, high blood pressure, hirsutism, diabetes, **thinning, etc. It is caused by GCS and metabolic disorders.

2) Induce or aggravate infection. The main reason is that hormones reduce the body's resistance to pathogenic microorganisms.

3) Induce or aggravate ulcer disease.

4) Induce hypertension and arteriosclerosis.

5) Osteoporosis, muscle atrophy, and delayed wound healing.

6) Induce psychosis and epilepsy.

7) Inhibition of children's growth and development.

8) Others: negative nitrogen balance, increased appetite, hypocalcemia, hyperglycemic tendency, peptic ulcer, euphoria.

9) Necrosis of the femoral head (in SARS**, 300 patients registered in Beijing were incapacitated due to the large use of glucocorticoids in SARS**).

2. Discontinuation reaction.

1) Adrenal cortex atrophy or insufficiency. Long-term users can reduce the dose too quickly or stop the drug abruptly, which can cause adrenal insufficiency. When GCS is used for a long time, it can cause cortical atrophy.

After abrupt discontinuation of the drug, if a state of stress is encountered, adrenal crisis can occur due to the lack of GCS in the body.

2) Rebound phenomenon and withdrawal symptoms.

Answer] :d adverse reactions caused by long-term and large use of glucocorticoids. Hypercortical syndrome.

Full moon face bridge bump, buffalo back, high blood pressure, hirsutism, diabetes, **sensitization, etc. It is caused by GCS and metabolic disorders. Induce or exacerbate the sensation of noisy reinfection.

The main reason is that hormones reduce the body's resistance to pathogenic microorganisms. Induces or worsens ulcer disease. Induces high blood pressure and arteriosclerosis.

Osteoporosis, muscle atrophy, and delayed wound healing. Induces psychosis and epilepsy. Inhibits children's growth and development.

a.The level of ACTH in the blood is elevated.

b.The amount of ACTH in the blood is decreased.

c.The amount of ACTH in the blood does not change.

d.The level of ACTH in the blood decreased first and then increased.

e.The amount of ACTH in the blood is sometimes high and sometimes low.

Correct answer: B

Answer]: eLong-term use of a large amount of glucocorticoids leads to an increase in the concentration of glucocorticoids in the blood, and the negative feedback fluid inhibits the secretion of pituitary ACTH, which atrophies the adrenal galax and reduces the self-synthesis of hormones.