Overview Cortisol (hydrocortisone) and its synthetic derivatives Glucocorticoid Drugs Drug Glucocorticoid activity Mineralocorticoid 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 login to view 1 more bullet 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 login to view 3 more bullets 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