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Overview 
  • Cortisol (hydrocortisone) and its synthetic derivatives 
Drug
Gluco corticoid activity
Mineralo corticoid activity
Duration
Cortisol 1 1 Short
Prednisone 4 0.3 Medium
Triameinolone 5 0 Intermediate
Betamethasone 25 0 Long
Dexamethasone 30 0 Long
 
  • Mechanism 
    • ↓ the production of leukotrienes and prostaglandins  
      • inhibits phospholipase A2
      • inhibits expression of COX-2
      • will also stimulate the bone marrow to produce neutrophils resulting in leukocytosis 
    • halts inflammatory cascade
      • ↓ leukocyte migration
      • ↓ capillary permeability
      • ↓ phagocytosis
      • ↓ platelet-activating factor
      • ↓ interleukins (e.g. IL-2)
    • may trigger apoptosis in dividing and non-dividing cells
      • used in cancer chemotherapy
  • Clinical use
    • anti-inflammatory
    • immunosuppression
    • cancer chemotherapy (prednisone most common)
      • CLL
      • Hodgkin's lymphomas
        • part of MOPP regimen
    • Addison disease
    • asthma
  • Toxicity
    • must taper dose to avoid toxicity
    • suppression of ACTH → shock state if abrupt withdrawal
      • cortical atrophy
      • malaise
      • myalgia
      • arthralgia
      • fever
    • iatrogenic Cushing  syndrome
      • characteristics fat deposition
        • buffalo hump
        • moon facies
        • truncal obesity
      • muscle weakness and atrophy
      • thin skin, easy bruising
      • acne
    • osteoporosis 
      • vertebral fractures
      • aseptic hip necrosis
    • ↓ skeletal growth in children
    • hyperglycemia (diabetes)
      • due to ↑ gluconeogenesis
      • glaucoma, cataracts, and other complications can subsequently result
    • ↑ GI acid release
      • ulcers
    • Na+ retention
      • edema, HTN
      • hypokalemia alkalosis
      • hypocalcemia
    • ↓ wound healing
    • ↑ infections
    • mental status changes
    • cataracts
 

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