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Review chapter 22. Anticonvulsants are used in patients with Epilepsy. First, what is is Epilepsy? Have you had any experience with seizures? What is the difference between a febrile and afebrile seizure? Lastly, what are the differences between the first and second generation Anticonvulsants and list two examples of each.


Use your own words when writing your post. You should include the reference at the bottom of your post should appear as follows: For example: 
Reference
DeVore, A. (2015). The electronic health record for the physician’s office. St. Louis, MO: Elsevier.

Essentials of Pharmacology for

Health Professions Eighth Edition

Chapter 17

Anti-infective Drugs

© 2019 Cengage. All rights reserved.

Introduction to Cost management© 2019 Cengage. All rights reserved.

Introduction

• Treatment of infection

– Complicated by the great variety of medications

available and their differing modes of action

– First step: identify the causative organism and specific

medication to which it is sensitive

▪ Culture and sensitivity (C&S) tests

o Wound, throat, urine or blood

o Usually not available for 24-48 hours

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Resistance (1 of 2)

• Organisms may build up resistance to drugs and are

therefore, no longer effective because of:

– Frequent use

– Incomplete treatment

• Anti-infective resistance is caused by many factors

– Complex strategies needed to combat the problem

• Seventy percent of bacteria that cause HAI’s are

resistant to at least one drug

– Example: MRSA

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Resistance (2 of 2)

• Selection of anti-infective drugs

– Infection site

– Status of hepatic and/or renal function

– Patient age

– Pregnancy or lactation

– Likelihood of organisms developing resistance

– Known allergy to the anti-infective drug

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Adverse Reactions

• Three categories

– Allergic hypersensitivity

▪ Over-response of the body to a specific substance

(anaphylaxis)

– Direct toxicity

▪ Results in tissue damage

– Indirect toxicity or superinfection

▪ Manifested as a new infection due to absence of normal

flora in the intestines or mucous membranes

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Vaccines/Immunizations

• Centers for Disease Control and Prevention (CDC)

– Currently recommends routine vaccination

▪ Prevent 17 vaccine-preventable diseases that occur in

infants, children, adolescents, or adults

▪ Information regarding vaccines and immunizations

changes from time to time and requirements may vary by

state, territory, or country

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Antibiotics

• Refers to a large spectrum of medicines that are useful

for treating and preventing infections by bacteria.

• No effect on viruses, fungal or other types of infection

• Improper use causes resistance

• Side effects, precautions, contraindications and

interactions are listed for each drug. Refer to the

Chapter text.

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Aminoglycosides

• Treats many infections caused by:

– Gram-negative bacteria (e.g., Escherichia coli and

Pseudomonas)

– Gram-positive bacteria (e.g., Staphylococcus aureus)

• Effective in short-term treatment of many serious

infections

– Septicemia (e.g., bacteria in bloodstream causing low

blood pressure) when less toxic drugs are ineffective or

contraindicated

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Cephalosporins

• Semisynthetic beta-lactam antibiotic derivatives

produced by a fungus

– Related to penicillins

▪ Some patients allergic to penicillin are also allergic to

cephalosporins

• Classified as first, second, third, or fourth, or fifth

generation

– According to organisms susceptible to their activity

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Macrolides

• Treats many infections of the respiratory tract, skin

conditions, or for some sexually transmitted infections

– Considered among the least toxic antibiotics

▪ Preferred for treating susceptible organisms under

conditions in which more toxic antibiotics might be

dangerous

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Penicillins

• Beta-lactam antibiotics produced from certain species

of a fungus

– Treats many streptococcal and some staphylococcal

and meningococcal infections

– Drug of choice for treatment of syphilis

– Used prophylactically to prevent recurrences of

rheumatic fever

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Carbapenems

• Belong to the beta-lactam class of antibiotics

– Have a very broad spectrum of activity against gram-

negative and gram-positive organisms

– Primary treatments include pneumonia, febrile

neutropenia, intra-abdominal infections, diabetic foot

infections, and significant polymicrobial infections

• See Table 17-1

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Quinolones

• For adult treatment of some infections of the urinary

tract, sinuses, lower respiratory tract, GI tract, skin,

bones, and joints, and in treating gonorrhea

– Some organisms are showing increased resistance

– Reserve for infections that require therapy with a

fluoroquinolone

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Tetracyclines

• Broad-spectrum antibiotics

– Treats infections caused by Lyme disease, rickettsia,

chlamydia, or some uncommon bacteria

– Some organisms are showing increasing resistance

– Use only when other antibiotics are ineffective or

contraindicated

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Antifungals (1 of 3)

• Treat specific susceptible fungal disease

– Medications are quite different in action and purpose

• Amphotericin B

– Administered IV for the treatment of severe systemic

and potentially fatal infections caused by susceptible

fungi, including Candida

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Antifungals (2 of 3)

• Fluconazole (Diflucan)

– Works against many fungal pathogens, including most

Candida, without the serious toxicity of amphotericin B

• Micafungin (Mycamine)

– Given IV

– Provides new treatment options against Candida and

Aspergillus species

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Antifungals (3 of 3)

• Nystatin

– Structurally related to Amphotericin B

– Orally treats oral cavity candidiasis

– Also used as a fungicide in the topical treatment of skin

and mucous membranes

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Antituberculosis Agents

• Tuberculosis (TB)

– Caused by a bacterium called Mycobacterium

tuberculosis, which primarily attacks the lungs

• Antituberculosis agents are administered for two

purposes

– To treat latent or asymptomatic infection (no evidence of

clinical disease)

– For treatment of active clinical tuberculosis and to

prevent relapse

– Treatment can be challenging

– See Table 17-2

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Miscellaneous Anti-Infectives (1 of 3)

• Clindamycin

– Treats serious respiratory tract infections, septicemia,

osteomyelitis, serious infections of the female pelvis

caused by susceptible bacteria, and for Pneumocystis

jirovecii pneumonia associated with AIDS

– Prophylactic use in dental procedures for penicillin-

allergic patients

– May be a viable therapeutic option for community-

acquired MRSA

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Miscellaneous Anti-Infectives (2 of 3)

• Metronidazole (Flagyl)

– Synthetic antibacterial and antiprotozoal agent

– Effective against protozoa

– One of the most effective drugs against anaerobic

bacterial infections

– Also useful in treating Crohn’s disease, antibiotic-

associated diarrhea, rosacea, and H. pylori infection

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Miscellaneous Anti-Infectives (3 of 3)

• Vancomycin

– Structurally unrelated to other available antibiotics

– IV vancomycin is used in the treatment of potentially life-

threatening infections caused by susceptible organisms

– Drug of choice for MRSA

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Agents for VRE

• Linezolid (Zyvox)

– Indicated for gram-positive infections

– Approved for the treatment of bacterial pneumonia skin,

skin structure infections, and MRSA and VRE infections

– Effective in treating diabetic foot infections

– Administered by IV infusion or orally

See Table 17-3

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Sulfonamides

• Among the oldest anti-infectives

– Increasing resistance of many bacteria has decreased

the clinical usefulness of these agents

• Used most effectively in combinations with other drugs

– Example: sulfamethoxazole and trimethoprim

– Resistance develops more slowly

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Urinary Anti-Infectives

• Urinary tract infection (UTI)

– Symptomatic inflammatory response from the presence

of microorganisms in the urinary tract

– One of the most common bacterial infections for which

patients seek treatment

– First-line urinary anti-infectives for empiric treatment of

uncomplicated lower UTI are sulfamethoxazole-

trimethoprim and nitrofurantoin

• See Table 17-4

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Antivirals

• Acyclovir

– Primarily treats herpes simplex, herpes zoster

(shingles), and varicella zoster (chickenpox) infections

• Neuraminidase inhibitors

– Indicated for the treatment of uncomplicated acute

illness due to influenza types A and B

• Ribavirin

– Treats infants and young children with respiratory

syncytial virus (RSV) infections via nasal and oral

inhalation, Lassa fever and Hepatitis C

• See Table 17-5

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Treatment of HIV/AIDS Infections (1 of 4)

• See Table 17-6

• Highly specialized field

– Those actively practicing in that field must be updated

frequently on the many new medications and frequently

changing protocols

• Treatment of HIV infection

– Consists of using highly active antiretroviral therapy

(HAART) combinations of three or more antiretroviral

(ARV) agents

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Treatment of HIV/AIDS Infections (2 of 4)

• Antiretroviral protease inhibitors (PIs)

– Block the activity of the HIV enzyme essential for viral

replication late in the virus life cycle

• Nucleoside reverse transcriptase inhibitors (NRTIs)

– Inhibit an enzyme responsible for viral replication early

in the virus life cycle

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Treatment of HIV/AIDS Infections (3 of 4)

• Non-nucleoside reverse transcriptase inhibitors

(NNRTIs)

– Inhibit an enzyme responsible for viral replication early

in the viral life cycle

• Fusion inhibitors (FIs)

– Block entry of HIV into cells, which may keep the virus

from reproducing

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Treatment of HIV/AIDS Infections (4 of 4)

• CCR5 antagonists

– Block a co-receptor required for HIV entry into human

cells

• Integrase inhibitor

– Raltegravir (Isentress): first ARV designed to slow the

advancement of HIV infection by blocking the enzyme

needed for viral replication

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HIV Information and Resources

• Sources of current recommendations for clinical use of

antiretrovirals (ARVs)

– Department of Health and Human Services

– Florida/Caribbean Aids Education and Training Center

– AETC National Resource Center Drug Interactions

– Johns Hopkins HIV Guide

– National HIV Telephone Consultation Service

– University of California, San Francisco

Essentials of Pharmacology for

Health Professions Eighth Edition

Chapter 22

Anticonvulsants, Antiparkinsonian

Drugs, and Agents for Alzheimer’s

Disease

© 2019 Cengage. All rights reserved.

Introduction to Cost management© 2019 Cengage. All rights reserved.

Introduction

• The following slides discuss various anticonvulsants,

antiparkinsonian drugs, and agents for Alzheimer’s

disease

– Refer to the chapter for specific side effects, precautions

or contraindications, and interactions

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Anticonvulsants (1 of 4)

• Seizures are brief abnormal neuronal discharges in the

brain that occur repeatedly and without warning

• Reduces the number and/or severity of seizures in

patients with epilepsy

– Epilepsy: 2 or more unprovoked seizures, characterized

by sudden attacks of altered consciousness, motor

activity, or sensory impairment

• Treatment is based on type, severity, and cause of

seizures

– Treatment failure can result from inappropriate

anticonvulsant selection

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Anticonvulsants (2 of 4)

• Two major groups

– Primary generalized seizures

▪ Begin with widespread electrical discharges that involves

both sides of the brain at once

▪ Further classified as convulsive or non-convulsive

– Partial seizures (focal)

▪ Begin with an electrical discharge in one limited area of

the brain

▪ No loss of consciousness (simple partial)

▪ Loss of consciousness (complex partial)

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Anticonvulsants (3 of 4)

• Primary Generalized Seizures

– Tonic-clonic: abrupt loss of consciousness; falling, with

tonic extension of trunk and extremities, followed by

alternating contractions and relaxation of the muscles

– Absence epilepsy: absence of convulsions; sudden

onset; brief loss of consciousness with no falling, usually

occurs in children

• Febrile seizures: most common childhood seizure

disorder; single, brief, and generalized

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Anticonvulsants (4 of 4)

• Partial seizures

– Caused by a lesion in the temporal lobe of the brain and

limited to one cerebral hemisphere

– Last from 10 seconds to five minutes

– Complex symptoms

– Can be preceded by an aura

• Unilateral seizures

– Affect only one side of the body

– Some patients may have mixed seizure patterns

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Drug Therapy for Generalized and Partial

Seizures

• First generation anticonvulsants

– Prophylactic treatment of generalized and partial

seizures should start with a single drug such as

valproate, lamotrigine, levetiracetam, carbamazepine,

oxcarbazepine, or phenytoin

▪ Aim of therapy is to prevent seizures without oversedation

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Drug Therapy for Febrile Seizures (1 of 2)

• Routine treatment of febrile seizures

– Involves searching for the cause of the fever and taking

measures to control it

– Most children with febrile seizures do not require

anticonvulsant drugs

▪ Those that do may be treated with rectal diazepam gel if

the seizure lasts longer than five minutes

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Drug Therapy for Febrile Seizures (2 of 2)

• Routine treatment of febrile seizures

– American Academy of Pediatrics Subcommittee on

Febrile Seizures does not recommend continuous or

intermittent antiepileptic drug (AED) therapy for children

with one or more simple febrile seizures

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Drug Therapy for Absence Seizures (1 of 3)

• Drug of choice for management of absence epilepsy is

Zarontin

– Effective only for this type of epilepsy

– Lacks idiosyncratic hepatotoxicity of valproic acid

• Other drugs in use include Klonopin, Depakene, and

Lamictal

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Drug Therapy for Absence Seizures (2 of 3)

• Second-generation anticonvulsants

– Neurontin, Lamictal, Keppra, oxcarbazepine, Topamax,

etc.

▪ For adjuvant treatment of partial (psychomotor) and

generalized seizures

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Drug Therapy for Absence Seizures (3 of 3)

• Second-generation anticonvulsants

– Compared to first-generation anticonvulsants

▪ Not yet considered superior in efficacy for seizure control

▪ Fewer adverse effects and drug interactions; does not

require drug level monitoring; daily dosing

• See Table 22-1

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Antiparkinsonian Drugs (1 of 6)

• Antiparkinsonian drugs are usually given for

Parkinson’s disease (PD)

– Chronic neurological disorder characterized by fine,

slowly spreading muscle tremors, rigidity, and

generalized slowness of movement

– Most common neurodegenerative disease in adults

– Severe disability in 10-20 years

– Underlying pathology is not completely understood

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Antiparkinsonian Drugs (2 of 6)

• Normal dopamine activity as it relates to acetylcholine

is diminished, with resulting relative overactivity of

cholinergic output

• Before interlining treatment, it is important to rule out

drug-induced parkinsonism (DIP)

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Antiparkinsonian Drugs (3 of 6)

• Dopamine replacement

– Carbidopa-Levodopa crosses the blood-brain barrier,

where it is converted to dopamine

▪ Enhances effects of levodopa, increasing therapeutic

effect of dopamine in CNS and reducing adverse

reactions

• Dopamine agonists

– Mirapex and Requip are commonly used in conjunction

with levodopa to delay onset of levodopa-caused

motor complications or given alone in early PD

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Antiparkinsonian Drugs (4 of 6)

• MAO-B inhibitors

– monoamine oxidase-B is responsible for breaking down

dopamine and tyramine in the brain

▪ In PD, increase levels of dopamine

• Selegiline (Eldepryl) and rasagiline (Azilect)

– Selective MAO type-B inhibitors

– Sometimes prescribed as adjunctive monotherapy for

early PD or after levodopa has been used for several

years

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Antiparkinsonian Drugs (5 of 6)

• Rasagiline (Azilect)

– The only MAO-B inhibitor approved as initial

monotherapy for PD

– Also approved as an addition to levodopa later in the

disease

• Anticholinergic agents

– restore the cholinergic-dopaminergic balance in PD

– Include synthetic atropine-like drugs, such as Cogentin

and Artane

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Antiparkinsonian Drugs (6 of 6)

• Amantadine

– Alters dopamine release

– Treats extrapyramidal reactions associated with

prolonged use of phenothiazines, carbon monoxide

poisoning, or cerebral arteriosclerosis

• COMT inhibitors

– Blocks the enzyme responsible for metabolizing

peripheral levodopa

– Increase concentration of levodopa and dopamine

• See Table 22-2

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Agents for Restless Legs Syndrome (1 of 2)

• Sensorimotor neurologic disorder characterized by a

distressing urge to move the legs, often accompanied

by a marked sense of discomfort in the legs

– Triggered by rest or inactivity and is temporarily relieved

by movement

– Follows a circadian pattern, with symptoms being most

intense in the evening and nighttime

– May be primary or secondary

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Agents for Restless Legs Syndrome (2 of 2)

• Primary RLS involves the CNS and dopaminergic

pathway

– Dopamine agonists Mirapex, Requip, and Neupro patch

are FDA-approved treatments

• Second-line agents

– Neurontin, benzodiazepines (such as clonazepam), and

opioids (hydroco-done, oxycodone, tramadol)

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Agents for Alzheimer’s Disease (1 of 4)

• Dementia

– Variety of diseases and conditions that develop when

nerve cells in the brain die or no longer function normally

• Alzheimer’s disease

– Devastating, progressive decline in cognitive function,

having a gradual onset, usually beginning between 60

and 90 years of age, followed by increasingly severe

impairment in social and occupational functioning

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Agents for Alzheimer’s Disease (2 of 4)

• Cholinesterase inhibitors

– Prevent breakdown of acetylcholine in the synaptic cleft,

thereby increasing acetycholine levels and improving

cognitive function

– Do not treat underlying pathology

– May slow the progression, but do not cure the disease

– Examples: Cognex, Aricept, Razadyne and Exelon

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Agents for Alzheimer’s Disease (3 of 4)

• NMDA receptor antagonist

– Namenda is thought to selectively block the excitotoxic

effects with abnormal transmission of the

neurotransmitter glutamate

– Can be used as monotherapy or in combination therapy

with cholinesterase inhibitors

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Agents for Alzheimer’s Disease (4 of 4)

• Decision on whether to continue drug therapy in

Alzheimer’s patients

– Based on quality of life, treatment goals, potential

benefits, adverse effects, and costs

▪ If quality of life is poor, stabilizing or slowing further

decline may not be an appropriate goal, and drug therapy

should be discontinued

• See Table 22-3

Essentials of Pharmacology for

Health Professions Eighth Edition

Chapter 23

Endocrine System Drugs

© 2019 Cengage. All rights reserved.

Introduction to Cost management© 2019 Cengage. All rights reserved.

Introduction (1 of 3)

• Endocrine

– Exerts its affects more slowly and over a longer period of

time

– Internal secretion (hormone) produced by a ductless

gland that secretes directly into the bloodstream

• Hormones

– Chemical messengers with specialized functions in

regulating activities of specific cells or organs

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Introduction (2 of 3)

• Endocrine system drugs

– Natural hormones secreted by ductless glands or

synthetic substitutes

• Endocrine system drug categories

– Pituitary hormones

– Adrenal corticosteroids

– Thyroid agents

– Antidiabetic agents

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Introduction (3 of 3)

• The following slides discuss various endocrine system

drugs

– Refer to the chapter for specific side effects, precautions

or contraindications, and interactions

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Pituitary Hormones (1 of 2)

• Pituitary gland: the master gland

– Regulates the function of the other glands

– Secretes several hormones

▪ Somatotropin (human growth hormone):

o Secreted by the anterior pituitary lobe

o Regulates growth

o Insufficient production will result in growth abnormalities

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Pituitary Hormones (2 of 2)

– Secrets several hormones (con’t)

▪ Adrenocorticotropic hormone (ACTH): Cortrosyn, a

synthetic peptide of ACTH, is used mainly for diagnosis of

adrenocortical insufficiency

– Treatment of associated disorders is usually reserved for

the corticosteroids

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Adrenal Corticosteroids (1 of 3)

• Adrenal glands secrete hormones called

corticosteroids

– Act on the immune system to suppress the body’s

response to infection or trauma

– Relieve inflammation, reduce swelling, and suppress

symptoms in acute conditions

– Two broad categories: replacement therapy and

immunosuppressant agents

– Corticosteroid therapy is not curative, but is used as

supportive therapy with other medications

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Adrenal Corticosteroids (2 of 3)

• Some conditions treated with corticosteroids

– Allergic reactions

– Acute flare-ups of rheumatic or collagen disorders

– Acute flare-ups of severe skin conditions

– Acute respiratory disorders

– Long-term prevention of symptoms in severe persistent

asthma or chronic management of COPD

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Adrenal Corticosteroids (3 of 3)

• Some conditions treated with corticosteroids (con’t)

– Malignancies

– Cerebral edema

– Organ transplant

– Life-threatening shock

– Acute flare-ups of ulcer