Clinical pharmacology of corticosteroids
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Clinical Pharmacology of Corticosteroids - PowerPoint PPT Presentation

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Clinical Pharmacology of Corticosteroids. Joe Collier. Aims. The session will describe: the class of corticosteroids generally how corticosteroids bring about their effects how corticosteroids can be used to: treat patients with deficiency or to modify disease

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Clinical pharmacology of corticosteroids

Clinical Pharmacology of Corticosteroids

Joe Collier

Clinical pharmacology of corticosteroids

  • The session will describe:

    • the class of corticosteroids generally

    • how corticosteroids bring about their effects

    • how corticosteroids can be used to:

      • treat patients with deficiency or

      • to modify disease

    • the key pharmacokinetic and pharmacodynamic properties of corticosteroids

    • the main unwanted effects of corticosteroids and ways in which these may be avoided

Clinical pharmacology of c orticosteroids
Clinical Pharmacology of Corticosteroids

  • Objectives - At the end of the session you should be able to:

    • describe the actions of corticosteroids (prednisolone, hydrocortisone, betamethasone, dexamethasone),

    • explain, where possible, the pharmacokinetics and pharmacodynamics of these drugs;

    • describe and explain their interactions and unwanted effects and how these can be avoided;

    • describe, briefly, the principles of their use

Examples of corticosteroids available
Examples ofCorticosteroids available

  • hydrocortisone

  • prednisolone

  • dexamethasone

  • beclomethasone

  • budesonide

  • fluticasone

Clinical pharmacology of corticosteroids

  • Corticosteroids are used:

    • to reduce inflammation (asthma, arthritis) and swelling (cerebral oedema)

    • to suppress the immune response (systemic lupus erythematosis)

    • to reduce nausea and vomiting (as in cancer chemotherapy)

    • to reduce terminal pain (associated with cancer)

    • as replacement therapy (in Addisons disease)

Unwanted effects


growth suppression

diabetes mellitus

muscle wasting


fat redistribution

skin atrophy





menstrual irregularities

adrenal suppression

Unwanted Effects

Unwanted effects1
Unwanted Effects

  • Other:

    • infection

    • emotional disturbances (psychosis, depression, mania)

    • cataract, glaucoma

    • GI bleeding, perforation

  • Withdrawal

    • Addisonian crisis

    • raised intracranial pressure

    • arthralgia/myalgia

    • pustular rash

How corticosteroids work
How corticosteroids work

  • Gross (metabolic) actions:

    • glucose: diabetogenic

      • (glucose uptake and utilisation; gluconeogenesis)

    • fat: Cushing’s syndrome

      • (redistribution, lipolysis)

    • protein: muscle wasting

      • (catabolism, anabolism)

    • minerals: hypertension (mineralocorticoid effect)

How corticosteroids work1
How corticosteroids work

  • Cellular (nuclear)* level:

    • anti-inflammatory and immunosuppressive actions:

      •  number and activity of leucocytes,

      • proliferation of blood vessels,

      • activity of mononuclear cells,

      • activity of cytokine secreting cells,

      • production of cytokines,

      • generation of eicosanoids and PAF,

      • complement components in blood,

      • histamine release

  • *Effect through gene transcription (lipocortin synthesis, inhibition of COX-2 synthesis). THIS TAKES TIME!

Avoiding unwanted effects of corticosteroids
Avoiding unwanted effectsof corticosteroids

  • Modification of dose/dose regimen

    • Use short courses/low doses if possible

    • Use steroid sparing drugs

    • Withdraw ‘chronic’ steroids slowly

    • Give dose once daily and in morning

    • Give on alternate days if possible

    • Give prophylactics if possible

    • Give product locally

    • Remember contraindications

    • Enrol help of patient

Avoiding unwanted effects of corticosteroids1

Steroid Selection:

remember, their effects can differ with regard to their mineralocorticoid and anti-inflammatory actions and duration of effect eg as parenteral products

or as topical products (creams)

hydrocortisone - mild

clobetasone but. - moderately potent

betamethasone - potent

clobetasol prop. - very potent

Avoiding unwanted effectsof corticosteroids

Giving products locally can still cause problems
Giving products locally can still cause problems!

  • systemic dosing can occur

  • local toxicity can develop -

    • skin: infection, thinning, bruising.

    • eye: viral infection, cataract, glaucoma.

    • inhalation: fungal infection, hoarseness

    • joints: infection, necrosis