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Steroids

Glucocorticoids

  • Natural
  • Cortisone Acetate
  • Hydrocortisone
    • 20mg eq, 1 anti inflame potency, 8-12hr, 1/125 mineralocorticoid
  • Pregnenolone
  • Synthetic
  • Cortisol like
    • Fludrocortisone (Florinef)
    • 1 mineralocorticoid potency
    • Methylprednisolone
    • 4mg eq, 5 anti inflame, 18-36hrs, no mineralocorticoid
    • Prednisolone
    • 5mg eq, 4 anti inflame, 18-36hrs, 1/150 mineralocorticoid
    • Prednisone
    • 5mg eq, 4 anti inflame, 18-36hrs, 1/150 mineralocorticoid
  • Methasones
    • Alclometasone
    • Beclometasone (Qvar)
    • Betamethasone
    • Clobetasol
    • Clobetasone
    • Dexamethasone
    • 0.75mg eq, 25-50 anti inflame, 36-54hrs, no mineralocorticoid
    • Fluticasone
    • Mometasone
    • Triamcinolone
  • Cyclic Ketals
    • Budesonide (Pulmicort)
  • Anti-glucocorticoids
  • Antagonists
  • Aglepristone
  • Ketoconazole
  • Mifepristone
  • Ulipristal Acetate
  • Synthesis modifiers
  • Ketoconazole
  • Muscle Relaxants
  • Succinylcholine
  • CI: Burns, Neuromuscular Disease/Paraplegia, Eye Trauma, Raised ICP
  • Anesthetic Induction Agents
  • Propofol, Midazolam, Sodium Thiopental
  • Steroids
    • Cushings, Sodium retention/K+ wasting (hypertension), osteopenia, ischemic bone necrosis, myopathy
  • Cancer Drugs
  • Calcineurin Inhibitors
    • block T cell activation by preventing IL-2 Transcription
    • Cyclosporine and Tacrolimus
    • Highly Nephrotoxic
    • Sirolimus (Rapamycin)
    • Not nephrotoxic

Glucocorticoid Cessation

  • Indications
  • Therapeutic benefit achieved
  • Uncontrolled SE (hypertension)
  • Severe complications (psychosis)
  • Risks
  • Adrenal insufficiency from HPA axis suppression
  • When to taper
  • ≥3 weeks of daily use
  • Cushingoid appearance