Corticosteroids or Glucocorticoids

Corticosteroids or Glucocorticoids

Corticosteroids are natural hormones released by the adrenal cortex that have powerful effects on most of the body cells. When used as a drug to treat diseases, the doses are many times higher than the amount naturally present in the blood.

Adrenal gland hormones:

  1. Adrenal cortex hormones
  • Corticosteroids or Glucorticoids
  • Hydrocortisone (aka Cortisol)
  • Corticosterone
  • Mineralcorticoids
    • Adlosterone
  • Adrenal Sex Hormones
    • Dehydroepiandosterone(DHEAS) –precursor of testosterone
  1. Adrenal Medulla Part of SNS
  • Noreepinephrine
  • Epinephrine (Adrenalin)


Functions of corticosteroids


Two 2 glucocorticoids: Cortisol(hydrocortisone) and Cortisone –although a little less active than cortisol, hepatic conversion makes them almost identical

  • Maintain adequate serum glucose
  • Promote breakdown of fats & Inhibit protein synthesis
  • Decrease GI absorption of calcium
  • Decrease formation of osteoblasts
  • Maintain nlcapillary permeability & vasomotor tone
  • Maintain fxof skeletal muscles
  • Affect CNS & mood excitability
  • As an anti-inflammatory or immunosuppressant they:
  • Decrease production of prostaglandins, cytokines, & interleukins
  • Decrease proliferation & migration of lymphocytes& macrophages


Uses

  1. Physiological dosing
    1. It is used to restore normal like in Addison’s disease
  2. Anti-inflammatory


They have ability to suppress histamine release and can inhibit certain functions of phagocytes and lymphocytes. They are used in many diseases to suppress the symptoms of the inflammation.

  1. Treatments of neoplasia


Corticosteroids can inhibit cell division in lymphocytes, the principal value of these agents is in the treatments of lymphomas, Hodgkin’s disease, and leukemia. They are given with chemotherapy to reduce nausea, weight loss and tissue inflammation.

  1. Asthma


Corticosteroids decrease the inflammatory process, which is main in the asthma.

  1. Arthritis


Examples

  • Systemic
  • Prednisone (Deltasone)
  • Methylprednisolone(Solu-Medrol)
  • Cortisone (Cortone)
  • Betamethasone(Celestone)
  • Fludrocortisone(FlorinefAcetate) -potent mineralcorticoid
  • Topical
  • Hydrocortisone
  • Inhaled
  • Beclomethasone(Vanceril)
  • Beclomethasone(QVAR )
  • Budesonide(PulmicortFlexhaler)
  • Flunisolide(AeroBid)
  • Fluticasone(Flovent)
  • Mometasone(AsmanexTwisthaler)
  • Triamcinolone(Azmacort)


Ophthalmic

  • Prednisolone(AK-Pred)


Side effects of corticosteroids by route of administrations

1. Oral administration
Because oral corticosteroids affect your entire body instead of just a particular area, this form is the most likely to cause significant side effects. Side effects depend on the dose of medication you receive. Within days or weeks of starting oral therapy, you may have an increased risk of:

  • Elevated pressure in the eyes (glaucoma)
  • Fluid retention, causing swelling in your lower legs
  • Increased blood pressure
  • Mood swings
  • Weight gain, with fat deposits in your abdomen, face and the back of your neck


When taking oral corticosteroids longer term, you may experience:

  • Cataracts
  • High blood sugar, which can trigger or worsen diabetes
  • Increased risk of infections
  • Loss of calcium from bones, which can lead to osteoporosis and fractures
  • Menstrual irregularities
  • Suppressed adrenal gland hormone production
  • Thin skin, easy bruising and slower wound healing


2. Inhaled corticosteroids
When using inhaled corticosteroids, some of the drug may deposit in your mouth and throat instead of making it to your lungs. This can cause:

  • Coughing
  • Hoarseness
  • Dry mouth
  • Sore throat


If you gargle and rinse your mouth with water — don’t swallow — after each puff on your corticosteroid inhaler, you may be able to avoid mouth and throat irritation. Although some researchers have speculated that inhaled corticosteroid drugs slow growth rates in children who use them for asthma, studies show that they do not affect their final adult height.
3. Topical corticosteroids
Topical corticosteroids can lead to thin skin, red lesions and acne.
4. Injected corticosteroids
Injected corticosteroids can cause side effects near the site of the injection.

  • Pain
  • Infection
  • Shrinking of soft tissue and loss of color in the skin


Considerations

  • Monitor for Adverse Effects -especially infection, elevated glucose
  • Use cautiously w/:
    • Pregnancy or lactation
    • Children
  • Pts who are immunocompromised or w/ high risk for infection
  • Patients with existing osteoporosis, DM, history of ulcer, conditions that have fluid imbalance (cardiac or renal disease or Hypertension), & Myasthenia Gravis
  • Significant Drug Interactions
  • Do not stop abruptly -d/t possible development of Adrenal Crisis
    • Hypotension
    • Shock
    • Hyperthermia
    • Hyponatremia
    • hyperkalemia