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Monday, December 22, 2014

Corticosteroids - Side Effects

What is corticosteroid ?


Corticosteroids are a chemical variant of the body's adrenal hormone. This group of substances suppresses various physical responses to inflammation and infection.

The adrenal hormones are produced by the outer zone (the cortex) of the adrenal glands. These hormones are mainly divided into two types:

-Glucocorticoids
-Mineralocorticoids

Glucocorticoids


An example is the hormone cortisol. Glucocorticoids are under the influence of ACTH (adrenocorticotropic hormone), that is secreted by the pituitary gland, are produced. They promote the conversion of proteins and fats into glucose. This increases blood sugar. They have an important function in the regulation of the activity of the immune system, to be strengthened issued in case of stress and suppress inflammatory reactions.

As a medicine to be prescribed in place of the naturally occurring cortisol especially synthetic derivatives. The following agents have been registered for use as a medicament: cortisone, hydrocortisone, prednisone, prednisolone, methylprednisolone, triamcinolone, betamethasone, dexamethasone. The first two have significant mineralocorticoid activity. The last 3 hardly at all. For local applications (eye drops, ear drops, nasal spray, inhalation, skin) are more resources available.

There are multiple routes of administration of corticosteroids:

-Oral: through ingestion (This is called than systemic absorption)
-Dermal: through the skin (especially in skin diseases.)
-Inhalation: an aerosol or powder is inhaled
-Intravenous: by infusion (usually in larger amounts or for imparting treatment)
-As eye drops
-By injection

Side effects of corticosteroids (eg medrol) in the longer term are:

-Osteoporosis
-Thinner skin (atrophy) and bruising
-Skin striae
-Typical redistribution of adipose tissue (neck, face)
-Muscle atrophy (this is disadvantageous in COPD)
-Cataract
-Poor wound healing
-High blood pressure (hypertension)
-Diabetes
-Adrenal insufficiency

For this last reason, the use of oral corticosteroids should never be stopped suddenly, but will be phased out in accordance with a reduction schedule.

Mineralocorticoids


An example is aldosterone. Mineralocorticoids have a regulatory effect on blood pressure and water and salt balance. They promote the reabsorption of sodium and water in the kidneys. They also promote the excretion of potassium by the kidneys. Registered as a medicine is the means Fludrocortisone, which has a much longer half-life than aldosterone.

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