๋ฐ์ฅ์์ฝ๋ฅดํฐ์ฝ์คํ ๋ก ํผ๋ฐ๋ ์ดํธ (DOCP)
**๋ฐ์ฅ์์ฝ๋ฅดํฐ์ฝ์คํ ๋ก ํผ๋ฐ๋ ์ดํธ(DOCP)**๋ ์ฃผ๋ก ๊ฐ์ ๊ณ ์์ด์ ์ ํ์ ์ธ ๋ถ์ ํผ์ง๊ธฐ๋ฅ์ ํ์ฆ(์ ๋์จ๋ณ) ๊ด๋ฆฌ์ ์ฌ์ฉ๋๋ ์ฅ๊ธฐ ์ง์ํ ์ฃผ์ฌ์ฉ **๋ฌด๊ธฐ์ง์ฝ๋ฅดํฐ์ฝ์ด๋**์ ๋๋ค. * **์์ ์์ :** ํ๋ฃจ๋๋ก์ฝ๋ฅดํฐ์๊ณผ ๋ฌ๋ฆฌ DOCP๋ ๋น์ง์ฝ๋ฅดํฐ์ฝ์ด๋ ํ์ฑ์ด **์ ํ ์์ต๋๋ค**. ๋ฐ๋ผ์ DOCP๋ฅผ ํฌ์ฌ๋ฐ๋ ํ์๋ ํนํ ์คํธ๋ ์ค๋ ์ง๋ณ ์๊ธฐ์ ๋น์ง์ฝ๋ฅดํฐ์ฝ์ด๋(์: ์๋ฆฌ์ ์ฉ๋์ ํ๋ ๋๋์ ๋๋ ํ๋๋ก์ฝ๋ฅดํฐ์)๋ฅผ ๋ฐ๋์ ํจ๊ป ๋ณด์ถฉํด์ผ ํฉ๋๋ค. * ๋ฏธ์ธ ๊ฒฐ์ ๋ฐํฌ ํํ์ก์ผ๋ก ์ ์กฐ๋์ด ์ฒ์ฒํ ์ฉํด๋๋ฉฐ ์์ฉ ์๊ฐ์ด ๊ธธ๊ฒ(์ผ๋ฐ์ ์ผ๋ก 21~30์ผ) ์ ์ง๋ฉ๋๋ค.
์์ฉ ๊ธฐ์ : DOCP acts as an exogenous analog of aldosterone. * **Target Site:** Acts primarily at the **renal distal tubule** and collecting ducts. * **Mechanism:** Binds to mineralocorticoid receptors โ upregulates **Na+/K+ ATPase** pumps and epithelial sodium channels (ENaC) โ increases the absorption of **sodium (Na+)** and enhances **potassium (K+)** and **hydrogen (H+)** ion excretion. * **Requirement:** To be effective, mineralocorticoids require a functioning kidney.
๋๋ฌผ ์ข ๋ณ ์ฉ๋
- Maintenance therapy of hypoadrenocorticism ยท 2.2 mg/kg IM every 25 days plus prednisolone (0.25-1 mg/cat PO twice daily; if daily oral dosing not feasible, may give 10 mg of methylprednisolone acetate once a month IM) ยท IM ยท q25d
- Maintenance therapy of hypoadrenocorticism ยท 10-12.5 mg (total dose) IM per month. Adjust dose based-upon follow-up serum electrolyte concentrations monitored every 1-2 weeks during initial maintenance period. Normal electrolyte values 2 weeks following injection, suggests adequate dosing, but does not provide information regarding duration of action. Prednisone at 1.25 mg PO once a day or IM methylprednisolone acetate 10 mg once a month can provide long-term glucocorticoid supplementation. ยท IM ยท monthly
- Hypoadrenocorticism ยท 2.2 mg/kg IM every 25 days ยท IM ยท q25d ยท Dosage requirements are variable and should be individualized to the patient.
- Hypoadrenocorticism ยท Initially, inject 2.2 mg/kg IM or SC every 25 days. Reevaluate at 12 and 25 days after initial injection. If hyponatremia and/or hyperkalemia are noted at 12 days, increase dose by 10%. If they are noted at 25 days (but not on day 12), shorten dosing interval by 2 days. ยท IM/SC ยท q25d
- Hypoadrenocorticism ยท 1.5-2.2 mg/kg IM q20-30 days ยท IM ยท q20-30d
- Hypoadrenocorticism ยท Initially, 2.2 mg/kg IM q25 days. If electrolytes remain in normal range at 30 days, reduce dose by 10% a month. In our clinic, we have used a dose of DOCP as low as 1 mg/kg q30 days with good control of hypoadrenocorticism. ยท IM ยท q25-30d
์ฉ๋์ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์ฐธ๊ณ ์๋ฃ์ ๋๋ค. ํญ์ ์ต์ ๋ผ๋ฒจ๊ณผ ๊ฐ๋ณ ํ์์ ๋ํด ํ์ธํ์ญ์์ค.
ํฌ์ฌ ๊ฒฝ๋ก
๊ธ๊ธฐ
- Congestive heart failure
- Severe renal disease
- Edema
์ด์๋ฐ์
- Injection site irritation
- Polyuria (PU)
- Polydipsia (PD)
- Hypernatremia
- Hypokalemia
- Hypertension
- Edema
- Weight gain (fluid retention)
์ฝ๋ฌผ ์ํธ์์ฉ
- Amphotericin B ยท Patients may develop hypokalemia if mineralocorticoids are administered concomitantly.
- Aspirin ยท DOCP may reduce salicylate levels.
- Digoxin ยท Because DOCP may cause hypokalemia, it should be used with caution and increased monitoring when used in patients receiving digitalis glycosides.
- Insulin ยท Potentially, DOCP could increase the insulin requirements of diabetic patients.
- Potassium-depleting diuretics (e.g., furosemide, thiazides) ยท Patients may develop hypokalemia if administered concomitantly; as diuretics can cause a loss of sodium, they may counteract the effects of DOCP.
๋ชจ๋ํฐ๋ง
- Serum electrolytes (Na+, K+)
- BUN and Creatinine (initially every 1-2 weeks, then once stabilized, every 3-4 months)
- Body weight
- Physical examination for edema
๊ณผ์ฉ๋
Overdosage may cause polyuria, polydipsia, hypernatremia, hypertension, edema, and hypokalemia. Cardiac enlargement is possible with prolonged overdoses. Excessive weight gain may be indicative of fluid retention secondary to sodium retention. **Treatment:** * Electrolytes should be aggressively monitored. * Potassium may need to be supplemented. * Discontinue the drug in patients until clinical signs associated with overdosage have resolved, then restart the drug at a lower dosage.
VetSheet ์ฝ๋ฌผ ๋ ํผ๋ฐ์ค๋ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์์ฌ๊ฒฐ์ ๋ณด์กฐ ๋๊ตฌ์ด๋ฉฐ, ์ ๋ฌธ์ ํ๋จ์ด๋ ์ ์กฐ์ฌ์ ์ต์ ๋ผ๋ฒจ์ ๋์ ํ์ง ์์ต๋๋ค.