Corticosteroids

1. CorticosteroidsCorticosteroids

2.  Corticosteroids – adrenal corticalCorticosteroids – adrenal cortical
hormoneshormones
 Classified as :Classified as :
GlucocorticoidsGlucocorticoids
MineralocorticoidsMineralocorticoids

3. GlucocorticoidsGlucocorticoids
 PrednisolonePrednisolone
 MethylprednisoloneMethylprednisolone
 TriamcinoloneTriamcinolone
 CortisoneCortisone
 HydroxycortisoneHydroxycortisone
 BudesonideBudesonide
 FluticasoneFluticasone
 DexamethasoneDexamethasone

4. Anti – inflammatory action of
glucocorticoids
 Suppress –Suppress – early (edema, pain, heat)andearly (edema, pain, heat)and
late (collagen synthesis, wound healing)late (collagen synthesis, wound healing)
components of inflammationcomponents of inflammation
 Prevents the formation of prostaglandins andPrevents the formation of prostaglandins and
leukotrienesleukotrienes
 Block the production and release ofBlock the production and release of
inflammatory cytokines (ILs, TNF-inflammatory cytokines (ILs, TNF-αα))

5.  Suppress the activation of T-cellsSuppress the activation of T-cells
 Reduce the process of chemotaxisReduce the process of chemotaxis
 Impair recruitment of leucocytes atImpair recruitment of leucocytes at
the sites of inflammationthe sites of inflammation

6. Immunosuppressant action of
glucocorticoids
 Suppress the cell mediated immunity (delayedSuppress the cell mediated immunity (delayed
hypersensitivity, graft rejection)hypersensitivity, graft rejection)
 Inhibit genes that code for the cytokinesInhibit genes that code for the cytokines 
IL1-6, IFN-¥IL1-6, IFN-¥
 Reduce T-cell proliferationReduce T-cell proliferation
 Interferes with function of complement andInterferes with function of complement and
NK-cellsNK-cells
 Also suppresses humoral immunityAlso suppresses humoral immunity

7. Uses of glucocorticoids
A. Endocrinal diseasesA. Endocrinal diseases
1.Acute adrenal insufficiency1.Acute adrenal insufficiency
(dehydration, hyponatremia, hyperkalemia,(dehydration, hyponatremia, hyperkalemia,
weakness, lethargy and hypotensionweakness, lethargy and hypotension
- i.v. hydrocortisone- i.v. hydrocortisone
2.Chronic adrenal insufficiency2.Chronic adrenal insufficiency
(Addison’s disease)(Addison’s disease)
- oral hydrocortisone- oral hydrocortisone

8. B. Non – endocrine diseasesB. Non – endocrine diseases
1. Anti-inflammatory therapy:1. Anti-inflammatory therapy:
 Rheumatoid arthritisRheumatoid arthritis
 OsteoarthritisOsteoarthritis
 Acute gouty arthritisAcute gouty arthritis
 Ulcerative colitisUlcerative colitis
 Crohn’s diseaseCrohn’s disease
 Topically:Topically:
- allergic conjunctivitis, iridocyclitis- allergic conjunctivitis, iridocyclitis
- Eczematous skin lesions- Eczematous skin lesions

9. 2. Immunosuppressive therapy:2. Immunosuppressive therapy:
 SLESLE
 Skin graft and organ transplantSkin graft and organ transplant
 Polyarteritis nodosaPolyarteritis nodosa
 Nephrotic syndromeNephrotic syndrome
 Haemolytic anaemiaHaemolytic anaemia
 Idiopathic thrombocytopenic purpuraIdiopathic thrombocytopenic purpura
 Myasthenia gravisMyasthenia gravis

10. 3. Bronchial asthma:3. Bronchial asthma:
 Inhaled or systemic glucocorticoidsInhaled or systemic glucocorticoids
in moderate to severe asthmain moderate to severe asthma
4. Severe allergic reactions4. Severe allergic reactions
 Anaphylactic shock (along with adrenaline)Anaphylactic shock (along with adrenaline)
 Angioneurotic edemaAngioneurotic edema
 Chronic urticariaChronic urticaria
 Hay feverHay fever

11. 55. Infective diseases. Infective diseases
 Pneumocystis jiroveciPneumocystis jiroveci pneumoniapneumonia
 TuberculosisTuberculosis
 Mycobacterium avium complex (MAC)Mycobacterium avium complex (MAC)
infectioninfection
- used ONLY as an adjuvant drug to- used ONLY as an adjuvant drug to
decrease the inflammatory reactiondecrease the inflammatory reaction

12. ADVERSE EFFECTSADVERSE EFFECTS
1. Cushing’s syndrome– moon face, buffalo1. Cushing’s syndrome– moon face, buffalo
hump, thin limbshump, thin limbs
2. Hirsutism2. Hirsutism
3. Hyperglycemia, precipitation of diabetes3. Hyperglycemia, precipitation of diabetes
4. Muscular weakness4. Muscular weakness
5. Osteoporosis5. Osteoporosis

13. 6. Increased susceptibility to infections6. Increased susceptibility to infections
7. Fetal abnormalities, growth retardation7. Fetal abnormalities, growth retardation
in childrenin children
8. Peptic ulceration, bleeding or8. Peptic ulceration, bleeding or
perforation of ulcersperforation of ulcers
9. Eye – glaucoma, cataract9. Eye – glaucoma, cataract

14. 10. Suppression of hypothalamo – pituitary10. Suppression of hypothalamo – pituitary
adrenal (HPA) axisadrenal (HPA) axis
 Depends on dose & duration of therapyDepends on dose & duration of therapy
 Withdrawal syndromeWithdrawal syndrome – malaise, fever,– malaise, fever,
anorexia, postural hypotension, flare up of theanorexia, postural hypotension, flare up of the
underlying diseaseunderlying disease
 Subjected to stress –Subjected to stress – acute adrenalacute adrenal
insufficiencyinsufficiency