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