Steroids ent
Upcoming SlideShare
Loading in...5
×
 

Like this? Share it with your network

Share

Steroids ent

on

  • 4,310 views

This presentation discusses the role of steroids in otolaryngology

This presentation discusses the role of steroids in otolaryngology

Statistics

Views

Total Views
4,310
Views on SlideShare
4,215
Embed Views
95

Actions

Likes
5
Downloads
108
Comments
0

2 Embeds 95

http://www.webicina.com 94
http://www.slashdocs.com 1

Accessibility

Categories

Upload Details

Uploaded via as OpenOffice

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Steroids ent Presentation Transcript

  • 1. Role of Steroids in otolaryngology Dr T Balasubramanian
  • 2. Introduction
    • Corticosteroids are small lipophilic molecules
    • 3. These molecules readily diffuse across cell membrane into the cytoplasm
    • 4. Inside the cytoplasm these molecules bind to the corticosteroid receptors present there.
    • 5. The steroid-receptor complex acts on transcription factors
  • 6. Action of steroid-receptor complex
    • This activated complex acts on transcription proteins found inside the cytoplasm
    • 7. Causes a reduction in the amount of inflammatory cytokines secreted by the cell
    • 8. Reduces the cells response to inflammation
    • 9. Due to this complex mechanism of action there is a time delay between the administration of the drug and its clinical activity
    • 10. Time delay of 3 hours is common
  • 11. Intravenous steroids
    • Useful during emergencies
    • 12. One hour is gained when the drug is administered intravenously
    • 13. Drugs with minimal mineralocorticoid effect is preferred
    • 14. Methylprednisolone / Dexamethasone are preferred as intravenous steroids
  • 15. Oral steroids
    • Used in patients who need long term administration of the drug
    • 16. Prednisolone is preferred to prednisone (prodrug)
    • 17. Prednisone needs to be metabolised in the liver into its active metabolites
    • 18. Dexamethasone is the most potent oral steroid with very negligible mineralocorticoid effect
  • 19. Depo injections - IM
    • Methyl prednisolone acetate is commonly used
    • 20. Its effect on the hypothalamic-pituitary-adrenal axis lasts for 3 weeks
    • 21. Usually administered once in 3 weeks intramuscularly
    • 22. Minimum plasma concentration after depo injection lasts for 3-4 weeks
  • 23. Intranasal steroids
    • Intranasally adeministered steroid should be lipophilic
    • 24. First pass metabolism is avoided
    • 25. Very low dose is enough for local effect – reduced systemic toxicity
    • 26. On administration 50% of the drug stays in the non ciliated anterior part of the nose while the other 50% is in the posterior ciliated columnar portion of the nasal cavity
  • 27. Intranasal steroid (contd)
    • Fluticasone propionate commonly used. Highly lipophilic and has a large tissue distribution volume
    • 28. Beclamethasone dipropionate / budesonide are less lipophilic and hence are rapidly absorbed into the circulation when applied as topical spray
    • 29. Spray administered in aqueous forms are better than aerosols.
    • 30. Topical application is effective on itching and sneezing
    • 31. Systemic application is better for blockage / anosmia
  • 32. Nasal topical steroids indications
    • Allergic rhinitis
    • 33. Vasomotor rhinitis
    • 34. Nasal polyposis
    • 35. Management of rhinitis medicamentosa
    • 36. Idiopathic rhinitis
  • 37. Systemic steroids
    • Oral
    • 38. Parenteral
    • 39. Depo (intramuscular)
  • 40. Systemic steroids indications
    • Angioneurotic oedema
    • 41. Acute allergic rhinitis
    • 42. Drug anaphylaxis
    • 43. Acute sensorineural hearing loss (sudden deafness)
    • 44. Treatment of acute hyposmia / anosmia
    • 45. Acute stridor before tracheostomy
    • 46. Acute epiglottitis
    • 47. Croup
  • 48. Systemic steroids indications (contd)
    • Otitis externa – to reduce external canal inflammatory oedema
    • 49. Bells palsy
    • 50. Nasal sarcoidosis
    • 51. Wegners granulomatosis
  • 52. Thankyou
  • 53. Steroid ear drops
    • Used to treat eczematous conditions of the skin lining fo external canal
    • 54. Used in the treatment of myringitis granulosa
    • 55. Can be used to reduce middle ear mucosal oedema in active middle ear infections with central perforation
    • 56. Long term use can cause atrophy of the skin lining of the external ear canal
  • 57. Intranasal steroid (contd)
    • Topical steroids when used on hyper reactive nose can cause increased sneezing
    • 58. Reassurance is a must and the drug should not be stopped
    • 59. Dry nasal mucosa / crusts / blood stained discharge seen in patients on long term nasal steroid therapy
    • 60. Prolonged usage may cause increased risk of cataract and osteoporosis