Clinical Use of Steroids

Sue Chan and Michael Randall

References
 Examples
Glucocorticoids
• Prednisolone (oral)
• Beclometasone (inhaled for asthma)
• Budesonide (asthma / lower GI)
• Hydrocortisone (cortisol) (oral, topical, i.v.)
Mineralocortocoids
• Fludrocortisone
 Pharmacology
• Act on intracellular receptors to alter gene
transcription ( ~ clinical response delayed for a
few days)
• Glucorticoids:
– Inhibit synthesis of COX-2 and inducible nitric oxide
synthase
– Inhibit synthesis of cytokines (interleukins, tumour
necrosis factor) and chemokines
– Stimulate production of lipocortin (which inhibits PLA2
and the synthesis of prostaglandins leukotrienes)
 Uses
Anti-inflammatory / immunosuppressive therapy
• Allergic/ septic emergency – i.v.
• Asthma, COPD – inhaled, oral (see Asthma tutorial)
• Ulcerative colitis, Crohn’s disease – oral, rectal (see lower GI tutorial)
• Rheumatoid arthritis - oral
• Skin conditions, e.g eczema, psoriasis – topical, oral
• Organ transplantation
• Others, inc. rhinitis, conjunctivitis

Replacement therapy
• Addison’s disease – need for steriod replacement, life-long. Hydrocortisone, 20mg AM,
10mg 6pm and fludrocortisone

Others
• Neoplastic disease
• Pre-term labour (enhance fetal lung maturation)
 Glucocorticoid side effects
Oral long term (> 3 weeks) may lead to:
• Diabetes
• Osteoporosis
• Mental disturbances
• Peptic ulceration (esp. with NSAIDs)
• Visual: cataract and glaucoma
• Cushing’s syndrome (at high doses)
• Suppression of growth (children)
• Adrenal suppression – sudden withdrawal can cause acute adrenal
insufficiency, hypotension and death
• Infections- increased susceptibility/ severity, particularly chickenpox
(and measles)
Steroid card for patients
 Mineralocorticoid effects
Aldosterone-type effects lead to:
• Sodium and water retention
• With potassium loss
• And may cause hypertension/ worsen CHF