MBBS Sem IV theory class

1. Anabolic Steroids
Dr. Pravin Prasad
M.B.B.S., MD Clinical Pharmacology
Lecturer, Lumbini Medical College
1 July, 2018 (17 Ashad, 2075), Sunday

2. By the endo of the class, MBBS Sem IV
students will be able to:
 List the anabolic steroids
 Explain the pharmacological basis of use of
anabolic steroids
 List the side effects of anabolic steroids
 List the contraindication of anabolic steroids

3. Pre-test
 Which of the following is the male sex
hormone:
A. Testosterone
B. Estrogen
C. Both A and B
D. None

4. Pre-test
 Which of the following is not an effect
of testosterone:
A. Development of sexual characters in
male
B. Pubertal growth spurt in males
C. Increasing the erythropoiesis in
females
D. Fusion of epiphyses in males
(Androgenic effect)
(Anaboliceffect)

5. Anabolic steroids: Introduction
 Synthetic androgens
 Higher anabolic activity
Anabolic: androgenic activity = 1 to 3
Lesser selectivity in human
 Are indicated in scenarios requiring only
the anabolic effects of testosterone

6. Anabolic steroids: Classification
 17α-alkyl substituted compounds:
Oxymetholone
Stanozolol
 Others:
Methandienone
Nandrolone
Testosterone
Stanozolol

7. Anabolic steroids: Mechanism of
Action
 Similar to testosterone

8. Anabolic steroids: Mechanism of
Action
 MOA:
Binds to androgen receptors (AR)
Interacts with the androgen response
elements
Modifies gene transcription in
presence of co-activators and co-
repressors

9. Anabolic steroids: Preparations
available
 Methandienone:
Oral tablets- 2mg, 5mg
Oral drops- 2mg/mL
Intramuscular injection-
25mg/mL
 Nandrolone:
Intramuscular injection-
10mg/mL, 25mg/mL, 100mg/mL

10. Anabolic steroids: Preparations
available
 Oxymetholone:
Oral tablets- 5mg, 50mg
 Stanozolol:
Oral tablet- 2mg
Intramuscular injection-
50mg/ampoule

11. Anabolic steroids: Uses
 Catabolic states
Acute illness, cancer
cachexia, major surgery
Acts by reducing N2 loss
Transient response only
seen
Indicated for short term
therapy
1
2
3

12. Anabolic steroids: Uses
Indication Basis of use of anabolic
steroids
Other/preferred
drugs
Osteoporosis In elderly males due to
prolonged immobilization
Alendronate,
Zolendronate
Suboptimal
growth in boys
Brief spurts in linear
growth seen
Useful in hypogonadism
Somatropin
Anaemia
(hypoplastic,
malignancy
associated,
haemolytic)
Increases RBC count and
Hb%
Erythropoietin

13. Anabolic steroids: Misuse
 Enhance physical abilities in athletes
Steroids+ exercise = increased
strength of muscle
Short-lived effects
Uncertain improvement in
performance
Considered illegal
Included in dope-test

14. Anabolic steroids: Side effects
 Cholestatic jaundice
 Lowering of HDL and rise in LDL levels
 Virilization, excess body hair and
menstrual irregularities in females
 Salt retention, edema

15. Anabolic steroids: Contraindications
 Carcinoma of prostate
 Carcinoma of male breast
 Liver and kidney disease
 During pregnancy

16. Future Prospects
 Selective Androgen Receptor Modulators
Ostarine, Andarine
Higher anabolic:androgenic ratio
Completed phase II clinical trials:
Decreased HDL levels
Increased AST/ALT
Not approved by US-FDA till date
Available as dietary supplements: illegal

17. Conclusion
 Anabolic steroids are synthetic
androgens with higher selectivity for
anabolic effects
 They are used for brief duration during
catabolic states
 Their use to boost athletic performance
is illegal
 SARMs are more selective for anabolic
effects of androgens

18. Questions??
Thank you!