Glucocorticoids vs corticosteroids usmle

4. A patient is admitted to the ER. The patient is unconscious on arrival. However, the patient’s family is with the patient and reports that before the patient became unconscious she was complaining of severe pain in the abdomen, legs, and back, and has been experiencing worsening confusion. In addition, they also report the patient has not been taking any medications. The patient was recently discharged from the hospital for treatment of low cortisol and aldosterone levels. On assessment, you note the patient’s blood pressure is 70/45. What disorder is this patient most likely experiencing?

Primary aldosteronism is characterized by high blood pressure, caused by increased retention of salt and water by the kidneys, and low serum potassium concentrations (hypokalemia), caused by excess excretion of potassium in the urine. The symptoms and signs of aldosterone excess include not only hypertension but also muscle weakness and cramps and increased thirst and urination. Primary aldosteronism is usually caused by a benign adrenal tumour (adenoma), but some patients have hyperplasia of both adrenal glands. Successful removal of the adrenal tumour usually results in reduction in blood pressure and cessation of potassium loss; patients with bilateral adrenal hyperplasia are treated with antihypertensive drugs.

Allegra and Zyrtec are both second generation antihistamines with a low risk of sedation. Allegra has the lowest risk of sedation out of all antihistamines so is preferred if an antihistamine is needed for people working in safety-critical jobs. Even though Zyrtec is times more likely to cause sedation than Allegra, it is still much less sedating than some older antihistamines such as promethazine. Allegra works within two hours and Zyrtec works within one hour. Several studies have found cetirizine (Zyrtec) to be more effective than fexofenadine (Allegra) at relieving symptoms of allergic rhinitis and urticaria, and it appears to have a longer duration of action. Studies have not compared the effects of Allegra and Zyrtec for conditions such as postnasal drip, but research suggests intranasal antihistamines such as azelastine are more effective. Allegra should not be taken with grapefruit juice. Zyrtec has no reported food interactions. Zyrtec and Allegra should not be taken at the same time, instead, if symptoms are persisting, it is better to take another drug with a different mechanism of action.

Guy W Soo Hoo, MD, MPH  Clinical Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Medical Intensive Care Unit, Pulmonary and Critical Care Section, West Los Angeles Healthcare Center, Veteran Affairs Greater Los Angeles Healthcare System

Guy W Soo Hoo, MD, MPH is a member of the following medical societies: American College of Chest Physicians , American College of Physicians , American Thoracic Society , Society of Critical Care Medicine , California Thoracic Society , American Association for Respiratory Care

Disclosure: Nothing to disclose.

Glucocorticoids vs corticosteroids usmle

glucocorticoids vs corticosteroids usmle

Guy W Soo Hoo, MD, MPH  Clinical Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Medical Intensive Care Unit, Pulmonary and Critical Care Section, West Los Angeles Healthcare Center, Veteran Affairs Greater Los Angeles Healthcare System

Guy W Soo Hoo, MD, MPH is a member of the following medical societies: American College of Chest Physicians , American College of Physicians , American Thoracic Society , Society of Critical Care Medicine , California Thoracic Society , American Association for Respiratory Care

Disclosure: Nothing to disclose.

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