Steroids

Question 1

What are some examples of steroids?

Answer 1

Glucocorticoids:
Prednisolone (oral)
Beclometasone (inhaled for asthma)
Budenoside (asthma/lower GI)
Hydrocortisone (cortisol, oral, topical, IV)
Mineralcorticoids:
Fludrocortisone

Question 2

How dos steroids work?

Answer 2

Act on intracellular receptors to alter gene transcription (clinical response delayed for few days)

Question 3

How do glucocorticoids work?

Answer 3

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)

Question 4

What are the anti-inflammatory/immunosuppreesive uses for steroids?

Answer 4

Allergic/septic emergency
Asthma, COPD
UC, Crohn's (oral, rectal)
Rheumatoid arthritis (oral)
Skin conditions- eczema, psoriasis (topical, oral)
Organ transplantation 
Rhinitis, conjunctivitis

Question 5

What are the other uses for steroids?

Answer 5

Replacement therapy- Addison’s disease
Others:
Neoplastic disease
Pre-term labour (enhance petal lung maturation)

Question 6

What is the dose of steroids used for Addison’s disease?

Answer 6

Need for steroid replacement, life long

Hydrocortisone 20mg AM, 10mg 6pm and fludrocortisone

Question 7

What are glucocorticoid side effects (oral long term >3 weeks)?

Answer 7

Diabetes
Osteoporosis
Mental disturbances
Peptic ulceration (esp w/ NSAIDs)
Visual (cataract and glaucoma)
Cushing's syndrome (high doses)
Suppression of growth (children)
Adrenal suppression 
Infections (particularly chickenpox and measles)

Question 8

What can sudden withdrawal of glucocorticoids lead to?

Answer 8

Acute adrenal insufficiency
Hypotension
Death

Question 9

What are mineralocorticoid side effects?

Answer 9

Aldosterone-type effects lead to:
Sodium and water retention
With potassium loss
May cause hypertension/worsen CHF