Steroids

• Steroids extracted from the adrenal cortex have two different major activities: glucocorticoid; mineralcorticoid

• Nearly all synthetic-steroid preparations have some degree of mixed effect, however, one of the two types of activity will predominate

Effects on Body Systems

Carbohydrate & Protein Metabolism

• Promote gluconeogenesis in liver

• In high dosages: osteoporosis, muscle wasting, increased protein catabolism

Fat Metabolism

• Movement of fat from peripheral deposits resulting in typical deposition on face & upper back

Electrolyte & Water Balance

• Salt & fluid retention [varies in extent between various steroid preparations]

Cardiovascular System

• Maintains cardiovascular status & capillary membrane integrity

• Excess results in hypertension

Muscle function

• Long periods of use results in muscle weakness & wasting

Nervous System

• Irritability, depression, apathy, psychosis

Lymphoid Tissue

• Induces lymphocytopaenia

Anti-inflammatory

• Suppress inflammatory responses in all tissues

Immune Response

• Suppress immunological response

Cushings Syndrome

• Adverse effect; inevitable complication of long term use of corticosteroids

• Physical: moon face, buffalo hump, abdominal striae, hirsitism, proximal muscle wasting

• Biochemical: hyperglycaemia, hypokalaemic alkalosis, changes in blood coagulability

• Neurological changes, hypertension, osteoporosis, increased susceptibility to infection

USES

• Replacement therapy resulting from adrenal insufficiency

• Antiinflammatory for asthma, rheumatoid arthritis

• Haematological: used in leukaemias to reduce proliferation of white cells

• Cerebral oedema

• Traumatic & allergic shock

• Diagnostic procedures: to assess function of adrenal cortex

Hydrocortisone [cortisol]

• short acting glucocorticoid

• naturally occurring

Prednisone

• Greater antiinflammatory but less salt retention than hydrocortisone

• An inactive drug that is metabolised in the liver to prenisolone, the active substance

• Patients with liver failure require prednisolone

Dexamethasone

• Long acting glucocorticoid

• Negligible salt retention