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Updated: Feb 21 2022

Glucocorticoids

Images
https://upload.medbullets.com/topic/109043/images/om_dryeye_september_a05_fig02.jpg
  • 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
          • 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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