USMLE

Corticosteroids

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Musculoskeletal Drugs
  1. Azathioprine
  2. Corticosteroids
  3. Sulfasalazine
  4. TNF Inhibitors
  5. Immunosuppressants (Cyclosporine, Mycophenolate, Tacrolimus)
  6. Acetaminophen
  7. NSAIDs
  8. Colchicine
  9. Allopurinol
  10. Rasburicase
  11. Dantrolene
  12. Muscle Relaxants
  13. Bisphosphonates: Alendronate, Risedronate

Summary

Corticosteroids are a class of drugs that include prednisone, dexamethasone, and hydrocortisone, among many others. These drugs have potent anti-inflammatory and immunosuppressive properties that make them effective in treating inflammatory autoimmune conditions like rheumatoid arthritis, ulcerative colitis, lupus, as well as for preventing organ transplant rejection. Corticosteroids may also given to people who have adrenal insufficiency, formally called Addison Disease. Common side effects of taking corticosteroids include hyperglycemia, fluid retention, GI distress, and muscle weakness. Osteoporosis and cataracts may also develop with long-term corticosteroid use. And finally, high or excessive doses of corticosteroids can precipitate a cortisol overload state, formally known as Cushing Syndrome.

Key Points

  • Corticosteroids
    • Key Drugs
      • “-sone”
        • Prednisone
          • Prednisolone
          • Methylprednisolone
        • Dexamethasone
        • Hydrocortisone
        • Fludrocortisone
        • Beclomethasone
    • Mechanism
      • Anti-Inflammatory
        • Glucocorticoid receptor antagonist / corticosteroids
        • Suppresses leukocytes and suppressing the inflammatory response
    • Clinical Use
      • Treat Inflammatory Diseases
        • Systemic Lupus Erythematosus (SLE)
        • Bell’s palsy
        • Psoriasis
        • Multiple sclerosis
        • Crohn’s disease
        • Ulcerative colitis
        • COPD
        • Rheumatoid arthritis
      • Treat Adrenal Insufficiency (Addison’s Disease)
        • Corticosteroids can be used to replace deficient levels of cortisol produced by the adrenal cortex
      • Immunosuppressant
        • Prevent organ transplant rejection
    • Side Effects and Adverse Reactions
      • Cushing syndrome
        • Caused by too much cortisol or corticosteroids
        • Moon face, puffy eyelids, pedal edema, increased bruising, menstrual irregularities, striae
      • Hyperglycemia
        • Diabetic patients will need to increase the amount of insulin they take
      • Fluid retention
        • Leads to weight gain
          • Monitor weight daily and report sudden increases in weight gain.
        • Leads to swelling
        • Leads to hypertension
      • Osteoporosis
        • Over long term use
        • Increased risk of bone fractures
      • Cataracts
        • Side effect of long-term use
      • Immunosuppression
        • Anti-inflammatory effects may mask signs of infection
        • Report even small signs of infection (like a low-grade fever)
      • Muscle weakness
        • Over long term use
      • Gastrointestinal distress
        • Nausea, vomiting, diarrhea, abdominal distention
        • Gastric ulcers if taken with NSAIDs. Acetaminophen is preferred for the use of pain management
        • May be given with food to reduce GI distress