{"id":8251,"date":"2020-04-27T21:40:12","date_gmt":"2020-04-28T00:40:12","guid":{"rendered":"https:\/\/doctorhoogstra.com\/es\/wiki\/corticosteroides-sistemicos\/"},"modified":"2020-10-30T07:36:45","modified_gmt":"2020-10-30T10:36:45","slug":"corticosteroides-sistemicos","status":"publish","type":"wiki","link":"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/","title":{"rendered":"Corticoster\u00f3ides sist\u00eamicos"},"content":{"rendered":"<p><\/p><div id=\"ez-toc-container\" class=\"ez-toc-v2_0_88 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Conte\u00fado<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Alternar tabela de conte\u00fado\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Alternar<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewbox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewbox=\"0 0 24 24\" version=\"1.2\" baseprofile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 eztoc-toggle-hide-by-default' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Que-es-un-sistemico-corticosteroides\" >O que \u00e9 um corticoster\u00f3ide sist\u00eamico?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#%C2%BFPara-que-se-usa-la-prednisona-en-dermatologia\" >Para que \u00e9 utilizado o prednisona na dermatologia?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#%C2%BFComo-funciona-un-esteroide-sistemico\" >Como funciona um ester\u00f3ide sist\u00eamico?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#%C2%BFComo-difieren-los-esteroides-sistemicos\" >Como os ester\u00f3ides sist\u00eamicos diferem?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#%C2%BFCual-es-la-dosis-habitual-de-prednisona\" >Qual \u00e9 a dose habitual de prednisona?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#%C2%BFCuales-son-los-efectos-secundarios-y-los-riesgos-del-esteroide-sistemico-a-corto-plazo\" >Quais s\u00e3o os efeitos colaterais e os riscos do ester\u00f3ide sist\u00eamico de curto prazo?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#%C2%BFCuales-son-los-efectos-secundarios-y-los-riesgos-del-esteroide-sistemico-a-largo-plazo\" >Quais s\u00e3o os efeitos colaterais e os riscos do ester\u00f3ide sist\u00eamico a longo prazo?<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Cutaneo-efectos-adversos\" >Efeitos adversos cut\u00e2neos<\/a><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Efectos-adversos-de-los-esteroides-sistemicos\" >Efeitos adversos de ester\u00f3ides sist\u00eamicos.<\/a><\/li><\/ul><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Efectos-sobre-la-grasa-corporal\" >Efeitos na gordura corporal.<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Efectos-en-el-ojo\" >Efeitos nos olhos<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Vascular-enfermedad\" >Doen\u00e7a vascular<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Tracto-gastrointestinal\" >Trato gastrointestinal<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Sistema-reproductivo\" >Sistema reprodutivo<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Musculoesqueletico-sistema\" >Sistema musculo-esquel\u00e9tico<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-16\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Sistema-nervioso\" >Sistema nervoso<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-17\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Efectos-metabolicos\" >Efeitos metab\u00f3licos<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-18\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Respuesta-inmune\" >Resposta imune<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-19\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Riesgos-durante-enfermedad-intercurrente-o-cirugia\" >Riscos durante doen\u00e7as ou cirurgias inovadoras<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-20\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Efectos-de-reducir-la-dosis-de-esteroides-sistemicos\" >Efeitos da redu\u00e7\u00e3o da dose de ester\u00f3ides sist\u00eamicos<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-21\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Monitoreo-durante-el-tratamiento-con-esteroides\" >Monitoramento durante o tratamento com ester\u00f3ides.<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-22\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/corticosteroides-sistemicos\/#Prevencion-de-osteoporosis\" >Preven\u00e7\u00e3o da osteoporose<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n\n<section class=\"textBlock\">\n<h2><span class=\"ez-toc-section\" id=\"Que-es-un-sistemico-corticosteroides\"><\/span>Que e um <span class=\"term\" data-term-id=\"380\">sist\u00eamico<\/span> corticoster\u00f3ides?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Um corticoster\u00f3ide tomado por via oral ou por inje\u00e7\u00e3o intramuscular \u00e9 chamado de ester\u00f3ide sist\u00eamico. Os ester\u00f3ides sist\u00eamicos s\u00e3o derivados sint\u00e9ticos do ester\u00f3ide natural, o cortisol, produzido pelas gl\u00e2ndulas supra-renais, e possuem profundos anti-<span class=\"term\" data-term-id=\"490\">inflamat\u00f3rio<\/span> efeitos<\/p>\n<p>Ester\u00f3ides sist\u00eamicos (corticoster\u00f3ides) tamb\u00e9m s\u00e3o chamados <span class=\"term\" data-term-id=\"1428\">glicocortic\u00f3ides<\/span> ou cortisonas. Eles incluem:<\/p>\n<ul>\n<li>Prednisona<\/li>\n<li>Prednisolona<\/li>\n<li>Metilprednisolona<\/li>\n<li>Beclometasona<\/li>\n<li>Betametasona<\/li>\n<li>Dexametasona<\/li>\n<li>Hidrocortisona<\/li>\n<li>Triamcinolona<\/li>\n<\/ul>\n<p>Prednisona e prednisolona s\u00e3o equivalentes e s\u00e3o os corticoster\u00f3ides orais mais comumente prescritos para doen\u00e7as inflamat\u00f3rias da pele. A prednisona oral \u00e9 o ester\u00f3ide sist\u00eamico mais comumente prescrito na Nova Zel\u00e2ndia.<\/p>\n<p>A fludrocortisona \u00e9 predominantemente um mineralocortic\u00f3ide e seus <span class=\"term\" data-term-id=\"1413\">anti-inflamat\u00f3rio<\/span> Os efeitos s\u00e3o m\u00ednimos.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"%C2%BFPara-que-se-usa-la-prednisona-en-dermatologia\"><\/span>Para que \u00e9 utilizado a prednisona em <span class=\"term\" data-term-id=\"55\">dermatologia<\/span>?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>A prednisona \u00e9 usada por alguns dias (a curto prazo) a indefinidamente (a longo prazo) em uma ampla variedade de doen\u00e7as da pele, incluindo:<\/p>\n<ul>\n<li><span class=\"term\" data-term-id=\"491\">Eczema<\/span>\/ \/<span class=\"term\" data-term-id=\"53\">dermatite<\/span><\/li>\n<li>\n<span class=\"term\" data-term-id=\"691\">Autoimune<\/span> <span class=\"term\" data-term-id=\"498\">bolhoso<\/span> doen\u00e7as\n<\/li>\n<li>L\u00fapus eritematoso<\/li>\n<li>Sarcoidose<\/li>\n<li><span class=\"term\" data-term-id=\"1091\">Vasculite<\/span><\/li>\n<\/ul>\n<p>\u00c9 melhor evitar os ester\u00f3ides sist\u00eamicos em pacientes com psor\u00edase.<\/p>\n<div id=\"square-placement-country-holder\" class=\"country-dependent advert\">\n<div class=\"box-placement square-placement\">\n<div class=\"advert__frame\">\n<div id=\"dermnet-dermnet-mobbox\">\n<\/div><\/div><\/div><\/div>\n<h2><span class=\"ez-toc-section\" id=\"%C2%BFComo-funciona-un-esteroide-sistemico\"><\/span>Como funciona um ester\u00f3ide sist\u00eamico?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Ester\u00f3ides sist\u00eamicos funcionam da mesma maneira que o cortisol natural. O cortisol natural tem efeitos importantes no corpo, incluindo a regula\u00e7\u00e3o:<\/p>\n<ul>\n<li>Prote\u00ednas, carboidratos, <span class=\"term\" data-term-id=\"1468\">lip\u00eddico<\/span> e <span class=\"term\" data-term-id=\"1360\">\u00e1cido nucleico<\/span> <span class=\"term\" data-term-id=\"934\">metabolismo<\/span>\n<\/li>\n<li>\n<span class=\"term\" data-term-id=\"148\">Inflama\u00e7\u00e3o<\/span> e resposta imune<\/li>\n<li>\n<span class=\"term\" data-term-id=\"69\">Distribui\u00e7\u00e3o<\/span> e excre\u00e7\u00e3o de \u00e1gua e solutos<\/li>\n<li>Secre\u00e7\u00e3o de horm\u00f4nio adrenocorticotr\u00f3fico (ACTH) de <span class=\"term\" data-term-id=\"1847\">gl\u00e2ndula pituit\u00e1ria<\/span>.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"%C2%BFComo-difieren-los-esteroides-sistemicos\"><\/span>Como os ester\u00f3ides sist\u00eamicos diferem?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Os ester\u00f3ides sist\u00eamicos diferem em dose, pot\u00eancia de mineralocortic\u00f3ides, meia-vida (dura\u00e7\u00e3o da a\u00e7\u00e3o) e qu\u00e3o efetivamente eles suprimem a <span class=\"term\" data-term-id=\"1358\">hipotal\u00e2mico<\/span>eixo hip\u00f3fise-adrenal (HPA) (a exclus\u00e3o leva a uma produ\u00e7\u00e3o reduzida de cortisol natural).<\/p>\n<table>\n<tbody>\n<caption>Compara\u00e7\u00e3o de ester\u00f3ides sist\u00eamicos *<\/caption>\n<\/tbody>\n<tbody>\n<tr>\n<th>Medicamento<\/th>\n<th>Cortisona<\/th>\n<th>Hidrocortisona<\/th>\n<th>Prednisona<\/th>\n<th>Metilprednisolona<\/th>\n<th>Dexametasona<\/th>\n<\/tr>\n<tr>\n<th>Dose equivalente<\/th>\n<td>25<\/td>\n<td>20<\/td>\n<td>5 5<\/td>\n<td>4 4<\/td>\n<td>0,75<\/td>\n<\/tr>\n<tr>\n<th>Pot\u00eancia mineralocortic\u00f3ide<\/th>\n<td>2+<\/td>\n<td>2+<\/td>\n<td>1+<\/td>\n<td>0-0.5 +<\/td>\n<td>0 0<\/td>\n<\/tr>\n<tr>\n<th>Meia-vida biol\u00f3gica<\/th>\n<td>8-12<\/td>\n<td>8-12<\/td>\n<td>24-36<\/td>\n<td>24-36<\/td>\n<td>36-54<\/td>\n<\/tr>\n<tr>\n<th>Dose di\u00e1ria causando supress\u00e3o do eixo HPA (mg)<\/th>\n<td>25-30<\/td>\n<td>20-30<\/td>\n<td>7.5<\/td>\n<td>7.5<\/td>\n<td>1\u20131,5<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>* Compara\u00e7\u00e3o sist\u00eamica de corticosteroides: Vancouver Coastal Health Formulary Tool. Recuperado em 12 de julho de 2014.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"%C2%BFCual-es-la-dosis-habitual-de-prednisona\"><\/span>Qual \u00e9 a dose habitual de prednisona?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Em geral, uma dose mais alta de prednisona, como 40 a 60 mg por dia, \u00e9 prescrita inicialmente para aumentar <span class=\"term\" data-term-id=\"1854\">ao controle<\/span> da condi\u00e7\u00e3o da pele. Em 2 a 4 semanas, a dose \u00e9 reduzida.<\/p>\n<p>A prednisona \u00e9 melhor tomada em dose \u00fanica pela manh\u00e3, o que se acredita reduzir a supress\u00e3o induzida por ester\u00f3ides do eixo pituit\u00e1rio-adrenal em compara\u00e7\u00e3o \u00e0 dosagem noturna.<\/p>\n<p>A dose de manuten\u00e7\u00e3o deve ser mantida o mais baixa poss\u00edvel para minimizar os efeitos adversos.<\/p>\n<p>A dosagem de ester\u00f3ides \u00e9 comumente caracterizada por:<\/p>\n<ul>\n<li>Dose baixa, p. Ex. <10 mg>\n<li>Dose m\u00e9dia, p. Ex. 10-20 mg \/ dia de prednisona<\/li>\n<li>Doses altas, p. Por exemplo,&gt; 20 mg \/ dia de prednisona, \u00e0s vezes mais de 100 mg \/ dia<\/li>\n<\/ul>\n<p>O tratamento por menos de um m\u00eas \u00e9 considerado tratamento de curto prazo. Os corticoster\u00f3ides por alguns dias ou semanas s\u00e3o relativamente seguros quando prescritos para <span class=\"term\" data-term-id=\"349\">agudo<\/span> dermatite. O tratamento que continua por mais de 3 meses \u00e9 considerado a longo prazo e produz a maioria dos efeitos colaterais indesej\u00e1veis.<\/p>\n<div id=\"square-placement-country-holder\" class=\"country-dependent advert\">\n<div class=\"box-placement square-placement\">\n<div class=\"advert__frame\">\n<div id=\"dermnet-dermnet-mobbox\">\n<\/div><\/div><\/div><\/div>\n<h2><span class=\"ez-toc-section\" id=\"%C2%BFCuales-son-los-efectos-secundarios-y-los-riesgos-del-esteroide-sistemico-a-corto-plazo\"><\/span>Quais s\u00e3o os efeitos colaterais e os riscos do ester\u00f3ide sist\u00eamico de curto prazo?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Os efeitos colaterais raramente s\u00e3o graves se um ester\u00f3ide sist\u00eamico tiver sido prescrito por um m\u00eas ou menos. Os seguintes problemas podem surgir, principalmente ao tomar doses mais altas:<\/p>\n<ul>\n<li>Dist\u00farbios de sono<\/li>\n<li>Aumento do apetite<\/li>\n<li>Aumento de peso<\/li>\n<li>Aumento de a\u00e7\u00facar no sangue p\u00f3s-prandial.<\/li>\n<li>Efeitos psicol\u00f3gicos, incluindo aumento ou diminui\u00e7\u00e3o de energia.<\/li>\n<\/ul>\n<p>Os efeitos colaterais raros e potencialmente graves de um ciclo curto de corticoster\u00f3ide incluem:<\/p>\n<ul>\n<li>Grave <span class=\"term\" data-term-id=\"145\">infec\u00e7\u00e3o<\/span>\n<\/li>\n<li>Mania, psicose, del\u00edrio, depress\u00e3o com inten\u00e7\u00e3o suicida.<\/li>\n<li>Insufici\u00eancia card\u00edaca<\/li>\n<li>Peptic <span class=\"term\" data-term-id=\"1278\">ulcera\u00e7\u00e3o<\/span>\n<\/li>\n<li>Diabetes Mellitus<\/li>\n<li>Avascular <span class=\"term\" data-term-id=\"403\">necrose<\/span> quadril <\/li>\n<\/ul>\n<p>O risco de um efeito colateral grave aumenta com o aumento da dose.<\/p>\n<p>Veja a p\u00e1gina DermNet em <span class=\"term\" data-term-id=\"1738\">profil\u00e1tico<\/span> tratamentos para pacientes dermatol\u00f3gicos com corticoster\u00f3ides sist\u00eamicos.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"%C2%BFCuales-son-los-efectos-secundarios-y-los-riesgos-del-esteroide-sistemico-a-largo-plazo\"><\/span>Quais s\u00e3o os efeitos colaterais e os riscos do ester\u00f3ide sist\u00eamico a longo prazo?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Quase todo mundo que toma um ester\u00f3ide sist\u00eamico por mais de um m\u00eas sofre de alguns efeitos colaterais, dependendo da dose di\u00e1ria e de quanto tempo toma o medicamento. As principais preocupa\u00e7\u00f5es s\u00e3o infec\u00e7\u00f5es, <span class=\"term\" data-term-id=\"561\">hipertens\u00e3o<\/span>, diabetes, osteoporose, necrose avascular, <span class=\"term\" data-term-id=\"1586\">miopatia<\/span>, <span class=\"term\" data-term-id=\"927\">cachoeiras<\/span>e <span class=\"term\" data-term-id=\"975\">glaucoma<\/span>. A lista a seguir est\u00e1 incompleta.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Cutaneo-efectos-adversos\"><\/span>\n<span class=\"term\" data-term-id=\"47\">Cut\u00e2neo<\/span> efeitos adversos<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Os efeitos colaterais sist\u00eamicos de esteroides a longo prazo podem incluir:<\/p>\n<ul>\n<li>\n<span class=\"term\" data-term-id=\"937\">Bacteriano<\/span> infec\u00e7\u00f5es: celulite, infec\u00e7\u00e3o de ferida\n<\/li>\n<li>\n<p>Infec\u00e7\u00f5es f\u00fangicas: micose, candida, <span class=\"term\" data-term-id=\"234\">pitir\u00edase<\/span> versicolor\n<\/li>\n<li>\n<p>Infec\u00e7\u00f5es virais: <a class=\"wpil_keyword_link\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/infeccion-de-herpes\/\" title=\"Herpes zoster\"><a class=\"wpil_keyword_link\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/infeccion-de-herpes\/\" title=\"Herpes zoster\">Herpes zoster<\/a><\/a>\n<\/li>\n<li>Afinamento da pele, <span class=\"term\" data-term-id=\"250\">roxa<\/span>, <span class=\"term\" data-term-id=\"1806\">fragilidade<\/span>, <span class=\"term\" data-term-id=\"281\">telangiectasia<\/span> e lenta cicatriza\u00e7\u00e3o de feridas, especialmente em \u00e1reas danificadas pelo sol<\/li>\n<li>\n<p>Estrias sob os bra\u00e7os e na virilha.<\/li>\n<li>Acne ester\u00f3ide<\/li>\n<li>\n<span class=\"term\" data-term-id=\"1809\">Hipertricose<\/span> e <span class=\"term\" data-term-id=\"122\">cabelo<\/span> perdido.<\/li>\n<\/ul>\n<section class=\"textBlock imageLinkBlockTitle\">\n<h5 class=\"colour--primary\"><span class=\"ez-toc-section\" id=\"Efectos-adversos-de-los-esteroides-sistemicos\"><\/span>Efeitos adversos de ester\u00f3ides sist\u00eamicos.<span class=\"ez-toc-section-end\"><\/span><\/h5>\n<\/section>\n<section class=\"imageLinkBlock\">\n<div class=\"flex\">\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='ss1__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisinkildewov0-2626781-1710659' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/ss1__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsInkiLDEwOV0-2626781.jpg'>\n<\/div>\n<p class=\"p-small\">Contus\u00f5es facilmente<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='ss2__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisinkildg1xq-3245712-5726429' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/ss2__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsInkiLDg1XQ-3245712.jpg'>\n<\/div>\n<p class=\"p-small\">Face da Lua<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='ss3__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-6467029-5089031' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/ss3__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-6467029.jpg'>\n<\/div>\n<p class=\"p-small\">Desbaste da pele<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='ss4__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-5802356-2497054' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/ss4__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-5802356.jpg'>\n<\/div>\n<p class=\"p-small\">Pele fr\u00e1gil<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='ss5__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisinkildm2xq-4175832-5976346' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/ss5__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsInkiLDM2XQ-4175832.jpg'>\n<\/div>\n<p class=\"p-small\">Acne<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='acne-steroids__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-2785565-8247338' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/acne-steroids__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-2785565.jpg'>\n<\/div>\n<p class=\"p-small\">Acne devido a ester\u00f3ides sist\u00eamicos.<\/p>\n<\/p><\/div>\n<\/section>\n<div class=\"clearfix imageLinkBlock\"><\/div>\n<h3><span class=\"ez-toc-section\" id=\"Efectos-sobre-la-grasa-corporal\"><\/span>Efeitos na gordura corporal.<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li>Redistribui\u00e7\u00e3o da gordura corporal: face da lua, corcunda de b\u00fafalo, obesidade no tronco<\/li>\n<li>Ganho de peso: aumento do apetite e ingest\u00e3o de alimentos.<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"Efectos-en-el-ojo\"><\/span>Efeitos nos olhos<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li>Glaucoma<\/li>\n<li>\n<span class=\"term\" data-term-id=\"239\">Mais tarde<\/span> catarata subcapsular; as crian\u00e7as s\u00e3o mais suscet\u00edveis que os adultos<\/li>\n<li>P\u00e1lpebra <span class=\"term\" data-term-id=\"201\">edema<\/span> e exoftalmia<\/li>\n<li>Central <span class=\"term\" data-term-id=\"748\">seroso<\/span> <span class=\"term\" data-term-id=\"1803\">coriorretinopatia<\/span>\n<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"Vascular-enfermedad\"><\/span>\n<span class=\"term\" data-term-id=\"753\">Vascular<\/span> doen\u00e7a<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li>Hipertens\u00e3o<\/li>\n<li>\n<span class=\"term\" data-term-id=\"765\">Isqu\u00eamico<\/span> doen\u00e7a card\u00edaca<\/li>\n<li>Acidente vascular cerebral e ataque isqu\u00eamico transit\u00f3rio (AIT)<\/li>\n<\/ul>\n<p>Os efeitos dos ester\u00f3ides sist\u00eamicos na <span class=\"term\" data-term-id=\"1385\">ateroscler\u00f3tico<\/span> A doen\u00e7a vascular pode ser devida a altera\u00e7\u00f5es metab\u00f3licas complexas, incluindo:<\/p>\n<ul>\n<li>Hiperlipidemia<\/li>\n<li>\n<span class=\"term\" data-term-id=\"1374\">Perif\u00e9rico<\/span> <span class=\"term\" data-term-id=\"1510\">insulina<\/span> resist\u00eancia e hiperinsulinemia.<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"Tracto-gastrointestinal\"><\/span>Trato gastrointestinal<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li>Dispepsia, gastrite, ulcera\u00e7\u00e3o p\u00e9ptica e <span class=\"term\" data-term-id=\"1431\">perfura\u00e7\u00e3o<\/span> do intestino, especialmente em pacientes que tamb\u00e9m tomam <span class=\"term\" data-term-id=\"1440\">anti-inflamat\u00f3rios n\u00e3o ester\u00f3ides<\/span>\n<\/li>\n<li>Agudo <span class=\"term\" data-term-id=\"886\">pancreatite<\/span>\n<\/li>\n<li>F\u00edgado gordo<\/li>\n<li>Balan\u00e7o de flu\u00eddos<\/li>\n<li>A reten\u00e7\u00e3o de s\u00f3dio e l\u00edquidos causa incha\u00e7o nas pernas e ganho de peso.<\/li>\n<li>Perda de pot\u00e1ssio causa fraqueza geral<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"Sistema-reproductivo\"><\/span>Sistema reprodutivo<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li>Menstrua\u00e7\u00e3o irregular<\/li>\n<li>Hirsutismo<\/li>\n<li>Fertilidade reduzida em homens (<span class=\"term\" data-term-id=\"1840\">hipogonadismo<\/span>) e mulheres<\/li>\n<li>Poss\u00edvel crescimento fetal atrasado em mulheres que tomam ciclos prolongados de ester\u00f3ides durante a gravidez<\/li>\n<li>A amamenta\u00e7\u00e3o geralmente pode continuar, mas a supress\u00e3o adrenal do beb\u00ea deve ser controlada se a m\u00e3e receber&gt; 40 mg de prednisona diariamente<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"Musculoesqueletico-sistema\"><\/span>\n<span class=\"term\" data-term-id=\"869\">M\u00fasculo-esquel\u00e9tico<\/span> sistema<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li>Fratura \u00f3ssea<\/li>\n<li>Osteoporose<\/li>\n<li>Osteonecrose, principalmente do quadril<\/li>\n<li>Miopatia que afeta os ombros e as coxas.<\/li>\n<li>Ruptura do tend\u00e3o<\/li>\n<li>Restri\u00e7\u00e3o de crescimento em crian\u00e7as<\/li>\n<\/ul>\n<p>A osteoporose \u00e9 particularmente comum em fumantes, mulheres na p\u00f3s-menopausa, idosos, baixo peso ou <span class=\"term\" data-term-id=\"1765\">ainda<\/span>e pacientes com diabetes ou problemas pulmonares. A osteoporose pode causar fraturas da coluna, costelas ou articula\u00e7\u00e3o do quadril com o m\u00ednimo <span class=\"term\" data-term-id=\"1365\">trauma<\/span>. Estes ocorrem ap\u00f3s o primeiro ano em 10 a 20% de pacientes tratados com mais de 7,5 mg de prednisona diariamente. Estima-se que at\u00e9 50% de pacientes com prednisona a longo prazo desenvolvam fraturas \u00f3sseas. As fraturas vertebrais s\u00e3o mais comuns em pacientes ester\u00f3ides, mesmo naqueles com densidade \u00f3ssea normal.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Sistema-nervioso\"><\/span>Sistema nervoso<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li>Efeitos psicol\u00f3gicos: mudan\u00e7as de humor, aumento de energia, excita\u00e7\u00e3o, euforia, agita\u00e7\u00e3o.<\/li>\n<li>Com menos frequ\u00eancia: hipomania, psicose, del\u00edrio, perda de mem\u00f3ria, depress\u00e3o, ansiedade, mudan\u00e7a de personalidade.<\/li>\n<li>Ins\u00f4nia e dist\u00farbios do sono.<\/li>\n<li>Tremores e tremores<\/li>\n<li>Dores de cabe\u00e7a<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"Efectos-metabolicos\"><\/span>Efeitos metab\u00f3licos<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li>Diabetes transit\u00f3rio ou persistente em pacientes anteriormente n\u00e3o diab\u00e9ticos<\/li>\n<li>N\u00edveis mais altos de a\u00e7\u00facar no sangue em pacientes com diabetes mellitus\n<\/li>\n<li>Cushing <span class=\"term\" data-term-id=\"350\">s\u00edndrome<\/span><\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"Respuesta-inmune\"><\/span>Resposta imune<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li>Alto <span class=\"term\" data-term-id=\"441\">neutr\u00f3filos<\/span> e contagem total de gl\u00f3bulos brancos s\u00e3o comuns na prednisona<\/li>\n<li>Imunidade inata e adquirida comprometida<\/li>\n<li>Maior suscetibilidade \u00e0 tuberculose.\n<\/li>\n<li>Maior gravidade do sarampo, varicela\n<\/li>\n<li>Reduzido <span class=\"term\" data-term-id=\"914\">efic\u00e1cia<\/span> e aumento do risco de vacinas\n<\/li>\n<\/ul>\n<p>Vacinas vivas como poliomielite ou MMR (sarampo, caxumba, rub\u00e9ola) n\u00e3o devem ser administradas a pacientes que tomam \u2265 20 mg de prednisona diariamente. \u00c9 seguro e aconselh\u00e1vel realizar outras vacinas de rotina, como a vacina\u00e7\u00e3o anual contra influenza.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Riesgos-durante-enfermedad-intercurrente-o-cirugia\"><\/span>Riscos durante doen\u00e7as ou cirurgias inovadoras<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Doen\u00e7a significativa significativa, trauma ou procedimento cir\u00fargico requer um aumento tempor\u00e1rio da dose de corticoster\u00f3ide ou, se descontinuado, uma reintrodu\u00e7\u00e3o tempor\u00e1ria da terapia com corticoster\u00f3ides por at\u00e9 doze meses ap\u00f3s a descontinua\u00e7\u00e3o dos ester\u00f3ides.<\/p>\n<p>Pacientes que tomaram \u226510 mg de prednisona diariamente dentro de 3 meses ap\u00f3s a cirurgia, necessitando de tratamento geral. <span class=\"term\" data-term-id=\"1206\">anest\u00e9sico<\/span> eles s\u00e3o encorajados a contar <span class=\"term\" data-term-id=\"1209\">anestesista<\/span> de modo que a hidrocortisona intravenosa intraoperat\u00f3ria possa ser adicionada.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Efectos-de-reducir-la-dosis-de-esteroides-sistemicos\"><\/span>Efeitos da redu\u00e7\u00e3o da dose de ester\u00f3ides sist\u00eamicos<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>N\u00e3o \u00e9 necess\u00e1rio diminuir se um curso de prednisona ocorrer por menos de uma ou duas semanas. Os ester\u00f3ides devem ser retirados lentamente ap\u00f3s ciclos mais longos, para evitar insufici\u00eancia adrenal aguda, principalmente se o medicamento for tomado por v\u00e1rios meses ou mais.<\/p>\n<p>Os efeitos colaterais da redu\u00e7\u00e3o da prednisona podem incluir:<\/p>\n<ul>\n<li><span class=\"term\" data-term-id=\"1176\">Febre<\/span><\/li>\n<li><span class=\"term\" data-term-id=\"626\">Hipotens\u00e3o<\/span><\/li>\n<li>Fadiga<\/li>\n<li>Dores de cabe\u00e7a<\/li>\n<li>Dores articulares e musculares.<\/li>\n<li>Perda de peso<\/li>\n<li>Depress\u00e3o<\/li>\n<li>Rinite<\/li>\n<li><span class=\"term\" data-term-id=\"1898\">Conjuntivite<\/span><\/li>\n<li>Pele com coceira dolorosa <span class=\"term\" data-term-id=\"367\">n\u00f3dulos<\/span>.<\/li>\n<\/ul>\n<p>A supress\u00e3o do eixo hipopituit\u00e1rio-pituit\u00e1rio-adrenal (HPA) pode persistir por meses ou anos ap\u00f3s a interrup\u00e7\u00e3o dos ester\u00f3ides.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Monitoreo-durante-el-tratamiento-con-esteroides\"><\/span>Monitoramento durante o tratamento com ester\u00f3ides.<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>O monitoramento regular durante o tratamento sist\u00eamico com ester\u00f3ides pode incluir:<\/p>\n<ul>\n<li>Press\u00e3o arterial<\/li>\n<li>Peso corporal<\/li>\n<li>Glicose no sangue<\/li>\n<\/ul>\n<p>Os pacientes que tomam prednisona devem ser aconselhados a evitar medicamentos anti-inflamat\u00f3rios n\u00e3o ester\u00f3ides e alca\u00e7uz.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Prevencion-de-osteoporosis\"><\/span>Preven\u00e7\u00e3o da osteoporose<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Os exames de densidade \u00f3ssea devem ser considerados para pacientes que tomaram ou se espera que tomem 7,5 mg ou mais de prednisona por dia durante tr\u00eas meses ou mais. <span class=\"term\" data-term-id=\"1747\">Base<\/span> O risco de fratura pode ser estimado a partir dos escores T. <\/p>\n<ul>\n<li>Consulte a p\u00e1gina da DermNet sobre tratamentos profil\u00e1ticos para pacientes dermatol\u00f3gicos com corticoster\u00f3ides sist\u00eamicos.\n<\/li>\n<\/ul>\n<p>As recomenda\u00e7\u00f5es atuais s\u00e3o:<\/p>\n<ul>\n<li>Terapia com bifosfonatos (alendronato, etidronato, \u00e1cido zoledr\u00f4nico) para indiv\u00edduos com escores T femorais <-2.5. Reduce el riesgo de fractura a la mitad.<\/li>\n<li>\n<p>De fumar <span class=\"term\" data-term-id=\"1505\">cessa\u00e7\u00e3o<\/span>\n<\/li>\n<li>Uma dieta equilibrada, com o objetivo de um peso corporal saud\u00e1vel.<\/li>\n<li>\u00c1lcool m\u00ednimo\n<\/li>\n<li>Exerc\u00edcio regular de sustenta\u00e7\u00e3o de peso<\/li>\n<li>Considere o risco de quedas e sua mitiga\u00e7\u00e3o.<\/li>\n<\/ul>\n<p>C\u00e1lcio, vitamina D e <span class=\"term\" data-term-id=\"1844\">estrog\u00eanio<\/span> n\u00e3o s\u00e3o mais recomendados para <span class=\"term\" data-term-id=\"1737\">profilaxia<\/span> osteoporose, como <span class=\"term\" data-term-id=\"909\">eventos adversos<\/span> Exceder o lucro.<\/p>\n<section class=\"textBlock\">\n<div class=\"grey-box\"><em><span style=\"font-size: 0.9em;\">As folhas de dados aprovadas da Nova Zel\u00e2ndia s\u00e3o a fonte oficial de informa\u00e7\u00f5es para esses medicamentos controlados, incluindo usos aprovados e informa\u00e7\u00f5es de risco. Veja a folha de dados individual da Nova Zel\u00e2ndia no site da Medsafe.<\/span><\/em><\/div>\n<\/section>\n<div class=\"clearfix\"><\/div>\n<\/section>","protected":false},"excerpt":{"rendered":"<p>Que es un sist\u00e9mico corticosteroides? Un corticosteroide tomado por v\u00eda oral o por inyecci\u00f3n intramuscular a menudo se llama esteroide sist\u00e9mico. Los esteroides sist\u00e9micos son derivados sint\u00e9ticos del esteroide natural,&#8230;<\/p>","protected":false},"author":8,"featured_media":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-8251","wiki","type-wiki","status-publish","format-standard"],"_links":{"self":[{"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/wiki\/8251","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/wiki"}],"about":[{"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/types\/wiki"}],"author":[{"embeddable":true,"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/comments?post=8251"}],"version-history":[{"count":0,"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/wiki\/8251\/revisions"}],"wp:attachment":[{"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/media?parent=8251"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/categories?post=8251"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/tags?post=8251"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}