Glucocorticoid
From Anvita Health Wiki
Contents |
More Specific Terms
- alclometasone (Aclovate, Acloson, Delonal)
- amcinonide (Cyclocort)
- beclomethasone (Vancenase, Beconase, Vanceril, Beclovent, Qvar)
- betamethasone (Celestone, Diprosone, Valisone, Diprolene, Soluspan)
- budesonide (Rhinocort, Pulmicort, Turbuhaler, Flexhaler, Entocort EC)
- clobetasol (Temovate, Clobex, Galderma)
- corticosterone
- cortisol; hydrocortisone (Cortef, Solu-Cortef, Alphaderm, Cetacort, Cortenema, Hytone, Nutracort, Westcort)
- cortisone (Cortone)
- desoximetasone (Topicort)
- dexamethasone (Decadron, Maxidex, AK-Dex, Ozurdex)
- diflorasone (Florone, Maxiflor)
- flunisolide (Nasalide, Nasarel AeroBid)
- fluocinolone (Synalar, Synemol, Fluonid, Derma-Smoothe/FS, Synandrone)
- fluocinonide (Lidex, Fluonex)
- fluorinated glucocorticoid
- fluoromethalone
- fluorometholone (FML)
- flurandrenolide (Cordran)
- fluticasone (Flonase, Veramyst, Flovent, Cutivate)
- halcinonide (Halog)
- halobetasol (Ultravate)
- halogenated steroid (glucocorticoid)
- inhaled glucocorticoid
- loteprednol (Lotemax, Alrex)
- medrysone
- methylprednisolone (Medrol, Solu-Medrol, Depo-Medrol)
- mometasone (Elocon, Asmanex, Nasonex)
- nasal glucocorticoid (nasal steroid)
- ophthalmic glucocorticoid (ophthalmic steroid)
- prednisolone; deltahydrocortisone; metacortandralone (Pred Forte, AK-Pred, Inflamase, Pediapred, Pred Mild, Prelone, Flo-Pred, Veripred 20)
- prednisone (Deltasone, Orasone, Liquid Pred, Meticortin)
- rimexolone (Vexol)
- topical glucocorticoid (topical steroid)
- triamcinolone (TAC, Aristocort, Arsitospan, Kenacort, Kenalog, Nasocort, Azmacort, Trivaris)
- tridesilon; prednacinolone (Desonide)
Dosage
- Equivalent anti-inflammatory doses of glucocorticoids:
* betamethasone 0.6 * dexamethasone 0.75 * triamcinolone 4 * methylprednisolone 4 * prednisolone 5 * prednisone 5 * hydrocortisone 20 * cortisone 25
Pharmacokinetics
Monitor
- blood glucose every 3 months
- blood pressure
- serum calcium
- serum potassium every 3 months [9]
- serum triglycerides
- ophthalmologic exam for long-term glucocorticoid use
- serum creatine kinase to detect steroid myopathy with use > 4 weeks
- monitor with systemic glucocorticoids
- monitor with immunosuppressive agents
Adverse-effects
-
- may inhibit osteoblast activity
- may promote osteoblast apoptosis
- inhibition of intestinal Ca+2 transport [8]
- aseptic necrosis
- ocular adverse effects
- bipolar symptoms
- begins 7-10 days after starting
- GI intolerance
- reduced tone of gastroesophageal sphincter
- gastroesophageal reflux
- upper GI bleed [5]
- accelerated atherogenesis
- immunosuppression
- disorder of neutrophil phagocytosis
- lymphopenia & monocytopenia
- decreased cell-mediated immunity
- opportunistic infections
- Cushingoid features:
- impaired wound healing
- steroid myopathy
- increased risk of atrial fibrillation
- oral candidiasis
- dysphonia ( laryngeal myopathy)
- topical glucocorticoids may cause contact dermatitis (3-5%) 21) inhaled glucocorticoids have no significant effect on final height or bone density in children [7] 22) long-term effects or antenatal exposure may be minimal (see betamethasone)
- * Calcium 1.0-1.5 g QD & vitamin D 400-800 IU QD may be helpful. Alendronate (or other bisphosphonate) may reduce bone loss & diminish risk of fractures [4].
Drug-interactions
- any drug that inhibits cyt P450 3A4 may increase levels of corticosteroids
- any drug that induces cyt P450 3A4 may diminish levels of corticosteroids
- drug interaction(s) of glucocorticoids with warfarin
Test-interactions
- increased neutrophil count ( in vivo effect)
- increase serum glucose ( in vivo effect)
- decreased thyroid binding globulin ( TBG)
Mechanism-of-action
- decrease vascular permeability
- inhibition of airway mucous gland secretion
- decrease in number of inflammatory cells, mast cells & T helper cells in airways
- decrease in mRNA expression of cytokines
- normalization of respiratory epithelium
- increased numbers of ciliated airway cells
- decreased number of goblet cells
- inhibition of phospholipase A2
- physiologic activator of apoptosis
- immunosuppression
More General Terms
Additional Terms
- glucocorticoid myopathy (steroid myopathy)
- glucocorticoid receptor (GR, nuclear receptor subfamily 3 group C member 1, NR3C1, GRL)
- steroid (glucocorticoid) injection
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 792, 799
- Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- Journal Watch 21(6):46, 2001 Arthritis Rheum 44:202, 2001
- Journal Watch 21(14):118, 2001 Hernandez-Diaz & Rodriguez, Am J Epidemiol 153:1089, 2001
- The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Prescriber's Letter 9(8):48 2002
- Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
- Anvita Health guideline :id 1522
- Anvita Health guideline :id 1523
- Anvita Health guideline :id 1524 - Prescriber's Letter 17(5): 2010 Using Oral Corticosteroids: a Toolbox Detail-Document#: &pb=PRL (subscription needed) [1]
- National Guideline Clearinghouse American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. ngc-guideline: [2]
