Corticosteroid

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Corticosteroids are medications that are related to [cortisol], a naturally produced hormone in the adrenal cortex. It reduces inflammation from various conditions such as [allergy|allergic reactions], skin conditions, breathing difficulties, some types of [cancer|cancers], blood diseases, and eye problems. It is also used in [hormone replacement therapy].

Contents

History

Corticosteroids were developed upon the isolation of the substance cortisone from the adrenal cortex by 1950 Nobel Prize recipients Tadeusz Reichstein, Edward Calvin Kendall, and Philip Showalter Hench. Lewis Sarett of Merck pioneered the production of cortisone from the 36-step process from ox bile. Russell Marker of Syntex used a simple 4-step method for producing progesterone from wild Mexican yams. Peterson and Murray of Upjohn was able to oxidize this progesterone with Rhizopus mold in 1952 for conversion to cortisone. It was thought to be a “miracle cure” for [arthritis] in 1948 when the Mayo Clinic at Rochester Minnesota gave daily injections of corticosteroids. However, the devastating effects wrought its havoc the longer the treatment was continued.

Types

In the Coopman classification, corticosteroids are clustered according to the similarity of their chemical structures. If one is allergic to a single corticosteroid of one class, there is significant risk of having an allergy to the rest of the cluster. This type of classification had been defined in 1989 by S. Coopman.

  • Group A: Hydrocortisone, cotisone, tixocortol, prednisolone, methylprednisolone, and prednisone.
  • Group B: Triamcinolone, mometasone, amcinonide, budesonide, desonide, fluocinonide, fluocinolone, and halcinonide.
  • Group C: Betamethasone, dexamethasone, and fluocortolone.
  • Group D: Hydrocortisone-17, aclometasone, prednicarbate, clobetasone-17, and fluprednidene.

Corticosteroids such as betamethasone and dexamethasone have very high [inflammation|anti-inflammatory] potencies. On the other hand, cortisone, hydrocortisone, prednisone, and prednisolone have pronounced mineralocorticoid activity.

Mechanism of action

Controlling salt and water balance and regulating metabolism of macromolecules (i.e. carbohydrates, fat, protein) are important roles cortisol does to the human body. Glucocorticoids perform the latter with pronounced anti-inflammatory effects while mineralocorticoids does the former function.

When experiencing stress, the pituitary gland releases adrenocorticotropic hormone (ACTH). This stimulates the adrenals to produce cortisol. Excess cortisol in the body allows it to cope from infection, [trauma], emotional problems or surgery. Once these stimuli ends, the release of cortisol ends. Every morning, the adrenals produce 20 milligrams of cortisol but can make five times that amount when needed.

Corticosteroids work on the immune system by stopping substances that will trigger it into action, such as allergies or inflammation. By doing so, they prevent white blood cells from destroying foreign bodies and from the immune system from working properly. This will increase risk for infections.

Uses

Corticosteroids are versatile powerful drugs that can be used for conditions that are caused by allergies or inflammation.

Inflammatory conditions such as rheumatoid and juvenile arthritis, [lupus], [ankylosing spondylitis], [inflammatory bowel disease], [dermatomyositis], [polymyositis], [Behcet's disease], [scleroderma], temporal arteritis, and [vasculitis] rely heavily on treatment with corticosteroids.

Glucocorticoids may be also be used to prevent organ rejection in transplants, treatment of lymphomas, brain edema, respiratory conditions such as [asthma] and skin problems such as dermatitis.

Recommended dosage of corticosteroids depend on the patient's condition, age, and weight as well as the type and dose available in the dosage form. The doctor might change the dosage during the course of treatment.

Precautions

Before being prescribed this type of medication, the patient must inform the doctor if these medical conditions exist:

  • Problems in the kidneys, liver, heart, or intestines
  • Active ulcers
  • [Hypertension|high blood pressure]
  • Underactive thyroid
  • Myasthenia gravis
  • Herpetic eye infection or any eye problems
  • [Tuberculosis]
  • [Seizure|seizures]
  • Blood clots
  • [Osteoporosis]
  • Allergies

Get clearance from the doctor before having any skin test or [immunization|vaccination] of any kind while on this medication. Infections of any kind must be reported immediately to the health care provider. Alcoholic beverages increases the risk of ulceration. Moreover, corticosteroids cause growth suppression in infants and children when taken for a long time.

Corticosteroids react with certain medications adversely. It is best to inform the doctor beforehand when [aspirin], arthritic medications, [anticoagulant|anticoagulants], [diuretic|diuretics], [rifampin], [phenobarbital], [birth control pill|birth control pills], [ketoconazole], and anti-[diabetes|diabetic] drugs are taken regularly.

Food supplements also interact with these medications. Topical application of aloe and licorice on the affected skin being treated by corticosteroids are beneficial. Taking [creatine] by children will reverse delayed growth caused by this medication.

Side effects

Initially, corticosteroids may cause dizziness, [nausea], [indigestion], appetite increase, weight gain, weakness, and sleep problems. These will eventually disappear when the body adjusts. The doctor should be informed once the symptoms become too bothersome or when bloody vomit, black stools, face puffiness, swelling of limbs, unusual weight gain, prolonged [sore throat] or [fever], muscle weakness, breathing difficulties, and mood or vision changes develop. Allergic reactions may also develop when rash, itching, swelling, dizziness, and swollen throat occur.

Safety issues

Corticosteroids may cause very serious body damage when used without medical supervision. Patients who use corticosteroids must coordinate with their doctors who will check periodically for the body's adverse reactions to the drug. It should be used only for the condition it was prescribed and must not be stopped abruptly. Patients on oral corticosteroids might be instructed to take it every other day to allow the body to make its own corticosteroids. Patients using inhaled corticosteroids must gargle and rinse the oral cavity after every use to prevent hoarseness and irritation of the throat.

Prescribing corticosteroids to children and teenagers must be carefully discussed with the doctor. The drug might stop, slow down, or affect the function of the adrenal glands. Another possible complication is that it might make infections, such as [chickenpox] and [measles], more deadly as the immune system is not working to rid itself of the pathogens. A permanent side effect would be growth retardation as these medications drain the body of calcium which [Fondue Forks is essential for reaching the potential adult height.

In the Philippines, the prolonged use of corticosteroids have been identified as one of the reasons that tuberculosis ravages in Northern Mindanao. The suppressed immune system cannot fight the mycobacteria and will eventually succumb to tuberculosis. It is also considered as one of the drugs that could trigger deadly [Stevens-Johnsons syndrome]. Symptoms could manifest 1 to 28 days after taking such medication, although there is 0.10^ probability that Filipinos might get it. On the other hand, studies showed that corticosteroids such as dexamethasone may improve the prognosis from neurotuberculosis. A recommendation of short course (6 months) triple anti-TB medications with corticosteroids guarantees cure.

References


DEFAULTSORT: Corticosteroid [Category: Medication] [Category: Pharmacology]