This lecture is on glucocorticoids. You know steroids are simply an organic compound with a specific structure. When discussing steroids many people think that we’re talking about anabolic steroids, you know those synthetic versions of testosterone that athletes you to build muscle. But corticosteroids are quite different. They’re a group of steroid hormone, which are made by the adrenal glands of the kidneys. Corticosteroids are actually classified as glucocorticoids and mineral corticoids. We’ll talk about glucocorticoids in depth in the following slides because they’re used so commonly in pharmacology and they have a tremendous impact on the immune systems inflammatory response. That’s why they’re used! Mineralocorticoids include aldosterone. This steroid regulates the balance of water and salt in the body. Corticosteroid medications are synthetic drugs that closely resemble cortisol. That’s our stress hormone! that’s made by the adrenal glands. Corticoidsteroid drugs are very powerful and they’re used to prevent or limit inflammation by suppressing the immune system. As you can see, they’re used by every route and they’re used for everything from brain tumors to skin conditions. We’ill see these drugs throughout the study of pharmacology and they’re used PO and IM, and IV. They’re used for arthritis or colitis. They may be used to prevent organ rejection and individuals that have organ transplants. They may be used topically for skin conditions or otic or opthalmic for eye or ear inflammation. Some nasal sprays may contain cortisone to decrease the swelling in the nasal passages and make it easier to breathe. Corticosteroids may be given by inhalation for inflammation that’s happening in the airway. They may also be given rectally for hemorrhoids or they may be injected directly into a joint to treat or help stop an inflammatory process in a joint. I think of these glucocorticoids as the number one drug for inflammation because the common generic ending of these medications is O-N- E,one. Examples are prednisone, dexamethasone, cortisone, and triamcinolone. I would like to paint you a picture of the effects cortisol has on the body so that you can understand and remember the side-effects and adverse effects the corticosteroid drugs. First off, know that cortisol is our stress hormone. It’s released by the adrenals in time of stress. So think about the side effects in terms of fight-or-flight. The body is not concerned with maintaining optimal function. It’s about survival so processes that are not critical for survival; these processes are shut down. Cortisol prevents the release of substances in the body that cause inflammation. When you’re under stress the body’s not seeing supporting the immune system as a priority when it’s in survival mode. So when the immune system is suppressed, inflammation is decreased. That’s the reason these drugs are prescribed is to decrease or prevent inflammation. Now under stress cortisol increases blood sugar as a survival method so we can escape the threat. Putting energy into digesting lunch, preparing for sex, optimizing the immune system, these are unimportant. These aren’t the priority when you’re under stress. So, cortisol suppresses immunity and decreases libido. Serotonin is one of our feel-good neurotransmitters. This level is decreased by high cortisol levels. Cortisol also helps with bone density. When cortisol is increased, calcium absorption is decreased. Cortisol, regulates metabolism of carbohydrates and proteins and fats. Lastly cortisol will increase sodium retention and potassium excretion. So remember that when glucocorticoid medications are used they do not have a big systemic effect when they’re used topically so always remember that. Also consider what cortisol does, now the side effects hopefully will make sense and be easier to remember. I use the letter S to think about the side-effects and adverse effects of corticosteroids. I think of sugar, salt, sex, sadness, sick, stop, and shrink bone. Prednisone is probably one of the most frequently used oral corticosteroids So hyperglycemia. Remember cortisol controls blood sugar. So remember sugar hyperglycemia. With retention of salt, patients may have edema. They can also have weight gain and appetite increased and hypertension. Libido is decreased because of these sex hormones. Serotonin is another S so think of sadness. Depression may be seen patient in patients that take these drugs. Because cortisol revs the body some may have even have anxiety or nervousness or insomnia as the brain kind of gets revved up. The next S is for sick. Because cortisol suppresses our immunity, patients on glucocorticoids can get sick easier. You know, that’s also why people who are always stressed and they’ve got high levels of cortisol, why they’re frequently sick. The cortisol also when it’s kicked in the immune system is suppressed, you may see poor wound healing. That wound healing is going to be prolonged. Inflammation begins wound healing so if we suppress it again, we may mess up the body’s ability to heal wounds, okay. Let me see what else. These have to be stopped gradually, because what happens is when we give the body artificial cortisol it quits making cortisol and actually the adrenals; they can even kind of shrink. So if they’re on patients are on these medications for any prolonged period of time, they want to gradually stop these. The docs will probably order a gradual dose. They’ll have them take you know, five for five days, and then take four, and then take three. So that’s how it’ll be ordered. The last S is for those spongy bones. Remember again, because of cortisol’s role in bone health and calcium patients who take corticosteroids long-term may have a higher risk of osteoporosis. Many individuals on long-term steroids are recommended to take vitamin D and calcium. For patient teaching for glucocorticoids, you should always include the direction to take as directed. You never want to stop these medications immediately if you’re taking them for any length of time. Again, watch for the side effects and the adverse effects that we just discussed. You want to monitor the patient’s white blood count and look for signs of infection. Again, the patient may have poor wound healing and be more susceptible to getting sick. You also should monitor vital signs, blood pressure, you know may go up and weight gain. Because of the multiple effects corticosteroids have on the body, these medications can cause serious problems if they’re not managed properly. Prolonged use of corticosteroids can cause problems with adrenal gland suppression and reduced immunity. A cushionoid appearance are signs and symptoms of excess cortisol. So think of Cushing’s as being crushed by cortisol, too much cortisol! Cushingoid appearance refers to the signs and symptoms associated with excess cortisol in the body regardless of the cause. Because of the fat redistribution that happens these patients may have moonface and acne. They may have a buffalo hump that happens. There’s also trunk obesity and stretch marks. You know, there is a Cushing’s disease and this is caused by a pituitary gland tumor which is usually benign but it causes an overstimulation of the adrenal glands and cortisol production. These patients will also have a cushioned appearance. Remember, cortisol is needed to maintain life. When individuals take corticosteroids the body senses higher than normal amounts of cortisol and the adrenal glands atrophy and stop making cortisol. So corticosteroid medication cannot be stopped suddenly or acute adrenal insufficiency can happen. When oral corticosteroids are prescribed the patient is usually directed to gradually again gradually decrease the dose. Addison’s disease, now this is a rare condition where your adrenal glands produce too little cortisol and often too little aldosterone. People with Addison’s disease can lead normal lives as long as they take their medication to replace these important hormones. Think of Addison’s as they need to add some cortisol. Well, that concludes the review of corticosteroids. I hope that makes it clearer and easier for you to understand and know those side effects. Let me know if you have any questions.