Updated: 8/24/2021

Glucocorticoids

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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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(M1.EC.14.30) A 67-year-old woman presents to the emergency room with jaw pain and vision loss. The patient reports several weeks of jaw pain, intermittent fevers, and neck pain. This morning she woke up and she couldn't see out of her left eye. The patient has a history of hypertension, hyperlipidemia, and diabetes. Her medications include lisinopril, atorvastatin, and metformin. Fundus examination reveals the following (Figure A). She is started on high dose steroids. She spends the night in the emergency room. On admission, her white count was 8.0. A follow up complete blood count reveals a white count of 18.2 with a neutrophilic predominance. What is the most likely cause of this change?

QID: 104036
FIGURES:
1

Bacterial infection

37%

(23/63)

2

Malignancy

0%

(0/63)

3

Lab error

6%

(4/63)

4

Drug effect

51%

(32/63)

5

Viral infection

6%

(4/63)

M 2 D

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