Mineralocorticoids and glucocorticoids礦物質皮質素和葡萄糖皮質素

main article: Endocrine and reproductive system內分泌和生殖系統、Taiwanese Antipyretic analgesics classification解熱鎮痛藥、Steroid hormone類固醇激素

• activity of Mineralocorticoids and glucocorticoids(礦物質皮質素和葡萄糖皮質素
  • Mineralocorticoids(礦物質皮質素=留鹽激素: salt(Sodium) retention / K+/H+ excretion and resultant increased blood pressure.Aldosterone醛固酮
  • glucocorticoids(葡萄糖皮質素: catabolism and antiinflammatory effect. 俗稱類固醇或是美國仙丹。

• 

  Mineralocorticoids and glucocorticoids both have the structure of 3-keto 4-ene steroid, thus these two activity can't be seperated. However, some of the glucocorticoids have almost no mineralocorticoids activity, we can classified Mineralocorticoids and glucocorticoids into 3 groups:
  • mineralocorticoids
  • glucocorticoids with mineralocorticoids activity
  • glucocorticoids with little or no mineralocorticoids activity

分類

mineralocorticoids

Aldosterone醛固酮

glucocorticoids with mineralocorticoids activity

.

glucocorticoids with little or no mineralocorticoids activity

.

Mechanism

• salt(Sodium) retention / K+/H+ excretion and resultant increased blood pressure:mineralocorticoids bind with its receptor
• catabolism:glucocorticoids(葡萄糖皮質素 bind with its receptor
• antiinflammatory effect:glucocorticoids藉由促進白血球中的蛋白質lipocortin的生成抑制PLA2

劑量換算

• 2016NEJS類固醇效價換算表，附抗發炎、礦物質作用圖
• NEJS類固醇劑量換算

品項	劑量比例	Conversion Factor	Equivalent Dose	Half-life (Biologic)	備註
Short-Acting（短效）
Cortisone	500	0.8	25	8-12
Hydrocortisone	400	1	20	8-12
Intermediate-Acting（中效）
Methylprednisolone	80
Prednisolone	100	5	4	18-36
Prednisone	100	4	5	18-36	基準
Triamcinolone	80	5	4	18-36
Long-Acting（長效）
Betamethasone	14.3	28	0.6-0.75	36-54
Dexamethasone	13.3	30	0.75	36-54

資料來源：http://blog.pixnet.net/mulicia/post/18790616

美國局部類固醇抗發炎強度七級

Topical glucocorticoid causes cutaneous vasoconstriction in proportion with their potency. With reference to the United States classification system, topical glucocorticoid can be classified into seven groups, with group 1 being the most potent and group 7 the least potent.

Super-high potency (Group 1)

• Betamethasone dipropionate, augmented 0.05%
• Clobetasol propionate 0.05%
• Diflucortolone valerate 0.3% (not available in the US)
• Fluocinonide 0.1%
• Flurandrenolide 4 mcg/cm²
• Halobetasol propionate 0.05%

High potency (Group 2)

• Amcinonide 0.1%
• Betamethasone dipropionate 0.05%
• Clobetasol propionate 0.025%
• Desoximetasone 0.25%
• Diflorasone diacetate 0.05%
• Fluocinonide 0.05%
• Halcinonide 0.1%
• Halobetasol propionate 0.01%

Higher-mid potency (Group 3)

• Amcinonide 0.1%
• Betamethasone dipropionate 0.05%
• Betamethasone valerate 0.1%
• Desoximetasone 0.05%
• Diflorasone diacetate 0.05%
• Diflucortolone valerate 0.1% (not available in the US)
• Fluocinonide 0.05%
• Fluticasone propionate 0.005%
• Mometasone furoate 0.1%
• Triamcinolone acetonide 0.5%

Medium potency (Group 4)

• Betamethasone dipropionate 0.05%
• Clocortolone pivalate 0.1%
• Fluocinolone acetonide 0.025%
• Flurandrenolide 0.05%
• Hydrocortisone valerate 0.2%
• Mometasone furoate 0.1%
• Triamcinolone acetonide 0.1%

Lower-mid potency (Group 5)

• Betamethasone dipropionate 0.05%
• Betamethasone valerate 0.1%
• Desonide 0.05%
• Fluocinolone acetonide 0.025%
• Flurandrenolide 0.05%
• Fluticasone propionate 0.05%
• Hydrocortisone butyrate 0.1%
• Hydrocortisone probutate 0.1%
• Hydrocortisone valerate 0.2%
• Prednicarbate 0.1%
• Triamcinolone acetonide 0.1%

Low potency (Group 6)

• Alclometasone dipropionate 0.05%
• Betamethasone valerate 0.1%
• Desonide 0.05%
• Fluocinolone acetonide 0.01%
• Triamcinolone acetonide 0.025%

Least potent (Group 7)

• Hydrocortisone (base, ≥2%) 2.5%
• Hydrocortisone (base, <2%) 1%
• Hydrocortisone acetate 2.5%

ADR

只要使用藥膏治療超過一週，病灶紅腫未改善或是範圍擴大時，回診為建議選擇。

藥化

有機化學官能基

雜環命名

• Mineralocorticoids and glucocorticoids both have the structure of 3-keto 4-ene steroid, thus these two activity can't be seperated. However, some of the glucocorticoids have almost no mineralocorticoids activity, we can classified Mineralocorticoids and glucocorticoids into 3 groups:
  • mineralocorticoids
  • glucocorticoids with mineralocorticoids activity
  • glucocorticoids with little or no mineralocorticoids activity

延伸學習

• 痛
• 止痛藥
• 風濕病
• 類固醇激素