5. Corticosteroids

Question 1

Examples of commonly used corticosteroids

Answer 1

hydrocortisone, prednisolone, methylprednisolone, triamcinolone, dexamethasone, betamethasone

Question 2

Example of mineralocorticoid synthetic analogue

Answer 2

Fludrocortisone

Question 3

Indication for mineralocorticoid synthetic analogue

Answer 3

used to treat conditions in which the body does not produce enough of its own steroids e.g. Addison’s disease, and salt-losing adrenogenital syndrome

Question 4

Anti-inflammatory actions of corticosteroids (gene targets)

Answer 4

Gene targets decreased by corticosteroids:
1. Cytokines: TNF-alpha, IL-2, IFN-gamma
2. Chemokines: RANTES
3. Inflammatory enzymes: COX2, 5-LOX, PLA2
4. Adhesion molecules: ICAM-1, VCAM-1
5. Receptors: IL-2R, T-Cell Receptor
→ Decrease expression of pro-inflammatory genes

Gene targets increased by corticosteroids:
1. Annexin-A1
2. B2-adrenoceptor
3. IkB-alpha
→ Increase expression of anti-inflammatory genes

Question 5

Anti-inflammatory actions of corticosteroids (cells)

Answer 5

1. decrease circulating T cells, B cells, monocytes, eosinophils & basophils, but increase circulating neutrophils
2. decrease size and lymphoid content of lymph nodes
3. have more effects on cellular immunity than humoral immunity
4. increase macrophage efferocytosis and promotion of resolution of inflammation
5. decrease type-IV delayed hypersensitivity reaction (e.g. transplant rejection)
6. first-line immunosuppressant in solid organ and hematopoietic stem cell transplantation

Question 6

Name 2 corticosteroids that have mineralocorticoid properties

Answer 6

hydrocortisone (cortisol) (high) and prednisolone (low)

Question 7

Principles in corticosteroid therapy

Answer 7

1. host response is the cause of symptoms
2. steroids are not curative
3. standard choice: shorter-acting steroids with little salt-retaining activity
4. at lowest possible dose (often still supra-physiological) to achieve desired effect
5. use alternate-day therapy or pulse therapy, if possible
6. do not stop abruptly (use stepwise dose reduction)
7. in prolonged therapy → chest X-ray, TB, DM, PUD, osteoporosis and mental disorder checked

Question 8

Side effects of corticosteroids

Answer 8

CORTICOSTEROIDS:
C-Cushing's syndrome 
O-Osteoporosis 
R-Retardation of growth 
T-Thin skin, bruising, striae 
I-Immunosuppression / Infection 
C-Cataracts & Glaucoma 
O-Obesity (abdominal weight gain)
S-Suppression of HPA axis 
T-Tired muscles 
E-Emotional disturbance 
R-Rise in blood pressure & lipids 
O-Oedema
I-Increased hair growth (hirsutism)
D-Diabetes mellitus 
S-Stomach upset and ulcers

Question 9

Short-acting corticosteroids

Answer 9

8-12h

1. Hydrocortisone

Question 10

Intermediate-acting corticosteroids

Answer 10

12-36h

1. Prednisolone
2. Methylprednisolone
3. Triamcinolone

Question 11

Long-acting corticosteroids

Answer 11

24-72h

1. Betamethasone
2. Dexamethasone