Steroids1
Introduction
Steroids
(also known as corticosteroids) are an important and potent group
of drugs. They are found in the body naturally as hormones, being
secreted by the adrenal glands. They have many different actions
in the body, involving the immune response, water and mineral metabolism,
anti-inflammatory action, etc.
Types
of Steroids
| i) |
Natural: found in the body as hormones, e.g., hydrocortisone,
corticosterone, aldosterone.
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| ii) |
Synthetic:
manmade (artificially made in laboratories) steroids, used as
drugs, e.g., prednisolone, betamethasone and dexamethasone.
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They
may be given orally or by injections, or used locally in the form
of ointments or creams.
Preparations
of Steroids
| Oral
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Short
acting |
-
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Cortisone |
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Hydrocortisone
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Intermediate
|
- |
Prednisone
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Prednisolone
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Long
acting |
- |
Dexamethasone
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Betamethasone
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| Topical
(for application to skin) |
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Low
potency |
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Hydrocortisone
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Medium
potency |
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Betamethasone
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Fluocinolone
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Beclomethazone
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Triamcinolone
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High
potency |
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Clobetasol |
Functions/Actions
of Steroids
| *
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Metabolic
actions - they influence the metabolism of carbohydrates,
fats, proteins, minerals and water. They raise the level of
glucose in the blood, and increase the breakdown of tissues
(resulting in wasting). The fat in the body is re-distributed
in the neck, shoulders and face. Salt (VVsodium chloride)
is retained in the body. Calcium absorption is reduced, and
this influences bone structures.
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Anti-inflammatory
action - they prevent or suppress the features of inflammation
such as pain, swelling, local warmth and redness. Thus there
is marked relief of these symptoms in inflammatory conditions
such as rheumatoid arthritis. However the cause of inflammatory
reaction is not controlled. This effect can be seen also when
steroids are applied locally in the form of a cream or ointment
to certain inflammatory skin conditions, e.g., eczema. |
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Anti-allergic
action - steroids suppress the body's
allergic response (response to foreign substances) directly,
as well as by their anti-inflammatory action. |
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Anti-immunologic action - steroids suppress the body's
natural immune mechanism against infection, and so increase
the susceptibility of the body to various types of infection
(bacterial, viral, fungal and parasitic). |
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Suppression
of natural hormones: Steroids given by mouth in high doses for
prolonged periods cause a decrease in the secretion of the natural
steroids in the body. Hence if they are stopped abruptly this
may lead to problems. |
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| Side
Effects of Steroids |
| * |
Ulceration of the stomach - may occur even with a few days of
. |
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| * |
Swelling of neck, face and obesity due to fat deposition. |
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Ulceration of stomach-may occur even with a few days of treatment.
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| * |
Weakening of the bones leading to fractures (a condition called
osteoporosis) |
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| * |
Glaucoma and cataract formation may occur in some patients using
steroid drops in the eye. |
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| * |
Raised blood pressure (hypertension), swelling of the body (edema).
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Symptoms and signs of diabetes. |
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Swelling of neck, face and obesity due to fat deposition.
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Decrease (retardation) of growth in children. |
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Masking (suppression) of signs and symptoms of serious infection. |
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| * |
Changes in body hair - increase in body hair, loss of scalp
hair may be seen. |
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| * |
Delayed wound healing,
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| * |
Aggravation
(increase in severity) of skin infections when applied locally.
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| * |
Skin
changes may be seen on local application, especially when potent
steroids are used - thinning of skin, lightening of skin colour,
easy bruising. |
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Uses
of Steroids
| a) |
In Addison's
disease, a condition where insufficient or no natural hormones
are produced in the body. |
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| b) |
In certain life threatening emergencies, when it is necessary
to suppress the inflammatory response of the body temporarily,
e.g., acute allergic reactions, acute asthma not responding
to ordinary drugs.
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| c) |
In certain other acute and chronic inflammatory conditions,
e.g., acute rheumatic fever, leukemia and some other cancers,
pemphigus and some other skin diseases, and rheumatoid arthritis.
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Ulceration
of the stomach - may occur even with a few days of taking steroids.
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Swelling
of neck, face and obesity due to fat deposition. |
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| d) |
In
certain inflammatory/allergic skin, eye and ear conditions,
e.g., eczema, psoriasis, and some types of inflammations of
the eye. |
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