26.01 Corticosteroids

Corticosteroids. So, in this video, we gonna talk about the steroids. Maybe, say, the steroid. Before we talk about the steroids’ mechanism of action, indication and side effects, let’s talk about a little bit about the adrenal gland. So, they have the adrenal gland on both kidneys, on the top of both kidneys. So, like, here’s the kidney and there’s an adrenal gland sitting on top of the kidney. Each kidney has one adrenal gland on top of that. What is the function of the adrenal gland? Adrenal gland secretes two types of hormone. First one is glucocorticoid and second one is called mineralocorticoids. Glucocorticoids, there are three endocrine enzymes are released from glucocorticoids are cortisol, corticosterone, and cortisone. While the mineralocorticoid is the aldosterone.

What is the function of glucocorticoid and mineralocorticoid? Let’s take a look at into the next slide. Glucocorticoid which is Cortisol, Corticosterone, and Cortisone. They increase the level of glucose in our body, increases the breakdown of protein and lipids. Basically, it’s preparing body to produce more energy. Decrease the inflammation and immune response. So, it will decrease the white cell count, it will decrease the inflammation, it will decrease basically the inflammation system like a production of histamine, and bradykinins and all inflammatory mediators. It increase the dilation of bronchial muscles and also affect the mood and brain excitability. So, if a patient, increased amount of glucocorticoid can change or alter the mood and make a person really labile to mood changes.

Mineralocorticoid which is aldosterone. What it does, it goes to the kidney and increase the sodium retention and absorption. And when it increase the sodium retention and absorption, we know this water is gonna follow the sodium, so, it will increase the water retention as well. So, basically, aldosterone is helpful in increasing the blood volume level.

Now, coming back to our main point, corticosteroid drugs. Corticosteroid medications are nothing but just a synthetic form of steroids. So, this is man made corticosteroids like all the enzymes are produced by the adrenal gland which include Cortisone, Hydrocortisone, Methylprednisolone, Prednisone, Betamethasone, Dexamethasone, and Triamcinolone. So, these medications were exactly same as these enzymes, mineralocorticoid and glucocorticoids.

Okay, now, since we know the function of these glucocorticoids and mineralocorticoids, we can relate the indication, like in which disease condition or in which specific condition we can use this medication for. So, now, the first one, let’s take a look. Skin disorder such as psoriasis, rash, allergic reaction and dermatitis. Now, we know one of the function of glucocorticoid is to decrease the inflammation and immune response. So, psoriasis, rash, allergic rash and dermatitis is basically are kinda inflammation and this medication will help to decrease those inflammation. Now, we also know that it dilates the bronchial vessels and it also decreases the inflammation.

So, asthma. Asthma is nothing but just the inflammation in bronchial, in the airway. So, if you give this medication to a patient, it will decrease the inflammation at the same time, it will dilate the bronchial muscle. It will help in asthma.

And also, if a patient has adrenal insufficiency, basically, if their adrenal gland is not producing enough glucocorticoids and mineralocorticoids, then these drugs can be given as a supplement. So, adrenal insufficiency.

In order to decrease immune system after organ transplant. So whenever any kind of organ transplant, like a kidney transplant, liver transplant, heart transplants, there is a high chance that, there’s a, that organ can be rejected by the patient’s immune system. So, this medication will be given after the transplant in order to decrease immune system of the patient. So, they will not have an organ rejection after transplant.

This one also given in the allergic rhinitis because it decreases the inflammation and also decreases the immune system as well. This one is given in Ulcerative colitis and Crohn’s disease where there’s basically inflammation of small intestine and large intestine. To decrease the edema associated with brain, renal and hepatic disorders. So, this one’s also used for the, to decrease the edema as well.

Okay, now, there is also another questions I have remember, they asks specifically for the asthma. Now you know, like in acute asthma attack, you give albuterol. However, if you have a choice, Albuterol and steroid. Which inhaler would you give first to patient? Like, would you give Albuterol first or steroid first? So, the answer is, you would give albuterol first. The reason is, when you give albuterol, it will dilate the airway and after dilation of the airway, you can give the steroid which will help to decrease the inflammation in the airway. If you give steroid first and it doesn’t do dilation of the airway, it’s not gonna go all the way and not gonna reach all the way down in the airway because of the inflammation and narrowing the airway. So, that’s why you wanna give the albuterol first and then the steroid.

These medications also used in the cancer such as leukemia and lymphomas. Leukemia and lymphomas is overproduction of WBCs. So, our body is key producing more and more and more WBCs. Not all of them are mature, like, immature WBCs. Now, these drugs suppress the immune system, suppress the production of white blood cells. So, this medication is also given for the leukemia and lymphomas as well. In joint inflammation such as rheumatoid arthritis and also given in a shock. Okay, so these are the medications are widely used in any hospital setting, outside hospital setting as well. I would say, these are the like, often used medication in ICU, in med-surg floor or even as a outpatient or like people are regularly on this medication.

So, what are the side effects and contraindication? As we know, like one of the side effects of the glucocorticoids can have a mood swing. ‘Cause as we talked, it can cause, people can have a really, people can be really labile to mood changes. So, it can cause the mood swings, it can cause the weight gain because it increases the sodium and water retention. Remember, mineralocorticoid increases the sodium retention aldosterone and also the water retention will cause the weight gain and also increase in appetite, would additionally cause the weight gain. Facial flushing, insomnia, it causes increase in fluid retention. Risk for infection because the immune system is gonna be suppressed. So, rick for infection, impaired would healing because the, due to the decrease in immune system. It can cause a peptic ulcer. Now, these medications can cause the osteoporosis because it decreases the absorption of calcium and can cause the possible bone fractures. But those are really rare, like for a patient who, like increased aged patient. This medication can cause the hypertension due, and also the congestive heart failure due to the increase in sodium and water retention. And also, it can suppress the hypothalamic-pituitary system because it’s the negative feedback system. So, if you’re giving a patient the steroid medicines, your brain, which is where the hypothalamus is, will say okay, we have enough steroids, enough steroids in our body, we don’t need to tell adrenal gland to function. So, basically, brain will shut down the adrenal gland. That’s basically the suppression of hypothalamic-pituitary system.

It is contraindicated in live vaccination, because it decreases in immune system, so you cannot give live vaccination to patient who are on steroids. It will actually, instead of creating antibodies, instead of their body creating antibodies for those vaccines, it will cause that disease. Potassium-depleting diuretics because this medication is also responsible for hypokalemia. So, one of the side effects, we all know, like it causes the hypernatremia, which is high sodium. It causes the hypokalemia. Sorry, I forgot to mention that one in the side effects. One of the side effects is hypokalemia as well. So, you do not want to give this medication with potassium-depleting diuretic because it will cause even more hypokalemia. You do not wanna give it with Digoxin because it can cause the cardiac arrhythmia. If you refer back to cardiac glycoside video, we talked about how Digoxin mechanism of action is based on sodium, potassium and calcium concentration. So, if this medication causes the hypokalemia, you cannot give, or you need to be really cautious giving Digoxin to this patient because it can cause the Digoxin toxicity and cardiac arrhythmia. With NSAIDs, it can cause the GI bleeds, non-steroidal anti-inflammatory drugs. And also, this medication decreases the effect of insulin and oral hypoglycemic agent. ‘Cause if you remember, this medication already increases the the glucose level and decreases the insulin effectiveness that will even cause more hyperglycemia in these patients as well. So, you need to be really careful.

So, that was it about the corticosteroids, really important class of drugs. If you have questions, feel free to ask us or e-mail us. Thank you.