This document discusses corticosteroids (glucocorticoids), including their mechanism of action, indications for use, specific drugs, administration routes, contraindications, and side effects. Glucocorticoids have anti-inflammatory and immunosuppressive effects through both acute and long-term mechanisms. They are used to treat a wide range of inflammatory and autoimmune conditions. Common corticosteroids discussed are hydrocortisone, prednisone, methylprednisolone, and dexamethasone. Side effects can involve many organ systems and include skin atrophy, hypertension, diabetes, osteoporosis, and psychiatric issues. Tapering is important when stopping long-term use to

1. By : Sabir Abdulrahman
Steroids (H.C, prednisolone,
methyl prednisolone,
dexamethasone )
UOD - college of medicine

2. Glucocorticoids are predominantly involved
in metabolism and have immunosuppressive,
anti-inflammatory, and vasoconstrictive
effects. Adrenal gland
Corticosteroids

3. Mechanism of action
Anti-inflammatory and immunosuppressive
Acute effects (within minutes)
↓ Vasodilation and ↓ capillary permeability
↓ Leukocyte migration to inflammatory foci
Long-term effects (within hours) : Glucocorticoids
bind to cytoplasmic glucocorticoid receptors (GRs)
Inhibition of neutrophil apoptosis and
demargination → neutrophilic leukocytosis
↑ Inhibition of phospholipase A2, → ↓ production
of leukotrienes and prostaglandins
Suppression of B cells and T cells (T cell apoptosis)
Inhibition of histamine release from mast cells

4. Mechanism of action
Mineralocorticoid properties
Cortisol can bind to mineralocorticoid receptors
at high concentrations .
Effects include, e.g., reduced sodium excretion,
increased potassium excretion
Anti proliferative: triggers cell apoptosis, and
inhibits fibroblast proliferation .
Anabolic-androgenic effects with steroid abuse
: increase in muscle mass and strength .

5. Replacement therapy
Adrenocortical insufficiency
Systemic symptomatic treatment
Allergic reactions and anaphylactic shock
Asthma
Acute exacerbation of COPD
Thyroid storm:
Rheumatic diseases (e.g., sarcoidosis, Sjogren syndrome)
Malignancy (e.g., CLL, non-Hodgkin lymphoma)
Local symptomatic treatment: anterior uveitis, dermatoses,
Prophylactic :Organ transplant
Preterm delivery: Glucocorticoids are given to the mother prenatally to induce
fetal lung maturity.
Indications

6. Hydrocortisone
Inflammation Status
asthmatics
Congenital adrenal
hyperplasia
Palliative
management of
acute leukemia
Drug
hypersensitivity
reaction
Congenital hypo-
plastic anemia
Hydrocortisone is the synthetic equivalent of endogenous cortisol and its
glucocorticoid and mineralocorticoid potency is considered to be “1”

7. Inflammation
Acute asthma
Nephrotic syndrome
Prednisolone
Prednisolone is one of the most commonly used glucocorticoids

8. Croup
Inflammation
Meningitis
Spinal cord compression
Dexamethasone
Cerebral edema associated brain tumor
Dexamethasone is a potent glucocorticoid with very little, if any, mineralocorticoid activity.

9. Inflammation
Status asthmatics
Pneumocystis jiroveci
pneumonia in AIDS
Severe lupus nephritis
Methylprednisolone
Methylprednisolone is a systemic synthetic corticosteroid, which, just as the naturally occurring gluco

10. Duration of action Drug Common route of
administration
Short acting
(8- 12 hours)
Hydrocortisone Oral
Injectable
Topical
Intermediate acting
(12-36 hours)
Prednisone Oral
injectable
Methyprednisolone Oral
injectabe
Long acting
(36-72 hours)
Dexamethasone Oral
injectable
Topical

11. Contraindications
General: hypersensitivity
Systemic
Systemic fungal infections
Intrathecal administration
Cerebral malaria
Concomitant live or live attenuated virus vaccination
Topical
Dermatological: bacterial, viral or fungal infection of the mouth or throat
Ophthalmic: Fungal or mycobacterial ocular infections, viral
conjunctivitis, or keratitis
Inhalation: status asthmaticus or acute asthma episode requiring intensive
measures

12. Organ/System of
organs
Effects
Skin
• Poor wound healing, skin atrophy, and stretch marks due to impaired fibroblast activity
and thus, impaired collagen synthesis
• Purpura
• Steroid acne
• Hypertrichosis
• Increased risk of squamous and basal cell carcinomas
Cardiovascular
system
• Hypertension
Metabolism,
electrolytes and
endocrine system
• Weight gain, buffalo hump, and moon face (Cushingoid appearance)
• Hyperglycemia and ↑ insulin resistance → glucocorticoid-induced diabetes
• Hypocalcemia → PTH activation → secondary osteoporosis

13. GI system
• Increased appetite
• Peptic ulcers and gastrointestinal hemorrhage
CNS and psyche
• Mood disorders
• Cognitive disorders
• Psychosis
Eyes
• Cataract
• Glaucoma
Other
• Adrenocortical atrophy
• Acute adrenal insufficiency
• Avascular bone necrosis [17]
• Glucocorticoid-induced osteoporosis, osteopenia
• Immunosuppression

14. Tapering to avoid toxicity:
▪ Short-term administration (≤ 3 weeks): usually no
tapering necessary
▪ Long-term administration (> 3 weeks): tapering
regimen based on patient age and condition and
on duration/dose of prior glucocorticoid
administration.
Additional considerations
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15. Any comments ?