Corticosteroids

1. Corticosteroids
Rajdeep Nandi
Group 20

2. Adrenal Medulla Adrenal Cortex
● Secretes -
ADRENALINE,
NOR-ADRENALINE,
DOPAMINE.
● Secretes -
GLUCOCORTICOIDS,
MINERALOCORTICOID
S.

3. Aldosterone → Major endogenous Mineralocorticoid
Actions
- Retain Na+ and water
- Remove K+ and H+
Mineralocorticoids

4. Hydrocortisone → Major endogenous Glucocorticoid
Actions
1. Catabolic Action
- Carbohydrates [CHO] breakdown to glucose → Avoided in DM
- Proteins breakdown → Myopathies can occur
- Fats breakdown [mainly from periphery] → Cushing Syndrome
- Ca + metabolism → Causes Osteoporosis
2. Anti-inflammatory Action
- Mainly by inhibition of chemotaxis
- Used in inflammatory conditions [itis]
- Cause delayed wound healing
Glucocorticoids

5. 3. Immunosuppressant Action
- Indicated in Transplantation and Autoimmune diseases
- But predispose to infections
4. Anti-Cancer Action
→ Indicated in
- Hodgkin Lymphoma
- Non-Hodgkin lymphoma
- Lymphocytic leukemia
5. Effect on Blood:
→ Glucocorticoids increase movement of neutrophils from bone marrow to
blood, but inhibit the movement of Lymphocytes from bone marrow to blood
→ Hence the net effects of glucocorticoids in blood is,
- Neutrophilia
- Lymphopenia
Steroids are not used in Kaposi sarcoma

7. Glucocorticoids
● Short Acting (<12 hours)
Cortisone
Hydrocortisone
● Intermediate Acting (12-36 hours)
Prednisone
Prednisolone
Triamcinolone
● Long Acting (> 36 hours)
Dexamethasone
Betamethasone
Paramethasone
Classification of Drugs
Mineralocorticoids
Aldosterone
Fludrocortisone
DOCA

8. ● Max. glucocorticoid activity (Anti-inflammatory
activity)
Dexamethasone
● Max. mineralocorticoid activity (Salt + water retaining
activity)
Aldosterone
● Glucocorticoid with max. mineralocorticoid activity
Hydrocortisone
● Mineralocorticoid with max glucocorticoid activity
Fludrocortisone

9. Glucocorticoid with Zero mineralocorticoid activity
(Selective glucocorticoid)
0- Zero
M- Mineralocorticoid activity
- Triamcinolone
- Dexamethasone
- Betamethasone
-Paramethasone
Mineralocorticoid with Zero Glucocorticoid Activity
(Selective mineralocorticoid)
0 → Zero
C → Cortisone like activity
- DOCA

10. Antenatal Uses
Dexa / Betamethasone for fetal
lung maturity (Glucocorticoids increase surfactant production)
Replacement Uses
Acute Adrenal insufficiency / Addisonian crisis [by IV]
Chronic Adrenal Insufficiency / Addison's
disease [by oral]
Other Uses
Inflammation
Auto immune diseases Transplantations
Anticancer therapy
Asthma
Uses of Corticosteroids

11. Ante Natal Steroids
Betamethasone → IM 12 mg every 24 hrs. x 2
Doses
Dexamethasone → IM 6 mg every 12 hrs. x 4
Doses
Total dose
24 mg
24 mg
Total duration
48 hrs.
48 hrs

12. Hypothalamo-Pitutary-Adrenal Axis [HPA
Axis]

13. → Occurs when corticosteroids are given
continuously for > 2wks
→ Preventive Measures
1. Stop unnecessary use of steroids
2. If indicated, prescribe them for minimum
period preferably < 2wks
3. If indicated for long periods, prescribe them
on Alternate day
- Long-acting steroids (dexa, beta and
paramethasone) are avoided
4. If indicated daily and for longer periods
- Don’t Stop Abruptly
- Tapering should be done
HPA Axis Suppression

14. 5. A person taking steroids since 3 months but person develops severe
infection (for stress induced under sx)
Do not stop steroids
External supplementation of steroids must be given to handle stress
If HPA suppression is already present and person is in emergency
Give steroids from outside even if infection develops (infection can be
treated with antibiotics)

15. Mechanism of Action

16. Adverse effects and Contraindications of Glucocorticoids
G → Glaucoma [Open angle glaucoma] [By long term topical steroids usage]
L → Limb muscle atrophy
U→ Ulcer [Peptic ulcer]
C → Cataract [Posterior subcapsular cataract] [Long term oral steroids usage]
0 → Osteoporosis
C → Cushing syndrome
0 → Osteonecrosis (Avascular necrosis of bone] [High dose of steroids]
R → Renal Failure
T → Tuberculosis [ileocecal]
I → Infections
C → CHF
O → Oedema
I → Impair healing
D → DM
S → Suppression of HPA axis Most dangerous complication].

17. Thanks