1)Mineral corticocoid:-Aldosterone
2) Glucocoticoids:- Hydrocortisone, prednisolone,Triamicinolone, Dexamethasone, Betamethasone.
Corticosteroid are synthesized in the adrenal cortex. The synthesis occurs under the influence of ACTH.
Mode of action:- After binding to the receptors, the steroid -receptor complex binds to the chromatin and stimulates the formation of MRNA. MRNA stimulates the the synthesis of enzymes. The anti inflammatory action is due to inhibition of prostaglandin and leucotreine synthesis.
The actions of glucorticoids are a) increased glucogenesis b) increased lipolysis C) increased liver store of glycogen d) CNS effects, euphoria.e) increased hemoglobin synthesis f) restrict capillary permeability and maintainance of cardiovascular functions. G) cause normal skeletal muscular function.h) anti inflammatory action i) suppression of immune response j) stabilize lysosomal membranes K) anti allergic action.
They are given by oral, parental, and tropical route. Oral bio availability of synthesis corticoid is high. Hydrocartisone after oral administration undergoes extensive mechanism in liver. They are metabolised in liver and after conjugation, are excreted in urine. The synthetic derivatives are metabolized slowly and have longer duration of action.
Aldosterone:- Mode of action:- It is a mineral corticoid. Its actions are a) sodium retention and reduction of serum k b) its acts on distal tubules of kidney to increase sodium re absorption.
Hydrocartisone:- this is a natural glucocorticoid. Mode of action :- same as corticoid. Indications: Rheumatoid arthritis, osteoarthritis, gouty arthritis, Joint sequelae of fractures. Administered as intra articular injection.b) Peri arthritis of hip,tendinitis, sinusitis, tenosynovitis, epicondylitis,cystic tumor of aponeurosis of tendon, scapulo humeral periarthritis treated by injection.
Dermatology:- Local intralesional injection. Hypertropic scars, keloids, inflammatory lesions of lichen planus, psoariatic plaques, discoid lupus of lichen planus, granuloma annulare.
Neurology;- Sciatica,lumbago, radiculopathies, multiple scerosis, tuberculosis- meningitis, otorlinolaryngology, nasal, polyposis, allergic rhinitis, allergic sinusitis, cicatrising lesions of middle ear.
EYE:- Episcieritis, scleritis, iritis, iridocyclitic, optic neuritis, retrobular neuritis,
Other uses:- Tubal stenosis, pleurisy, pericarditis, peritonitis.
Special precautions:- Under aseptic condition injection is to be given. Use to be avoided in anterior part of scalp because of risk of micromebolization.
Preparation of hydrocartisone succinate:- Indications:- status asthmaticus, and acute allergic reaction to drugs, severe shock( surgical accidental trauma, or overwhelming infection) Addison’s disease, simmon’s disease, tubercular meningitis, and other meningitis.
Dosage:- adults: ( usually 100mg I.M. or I.V. repeated as required, in severe cases up to 300mg first dose.
children:- 3-6microgram/kg 24 hours in divided dose, Brand Name: Inj. Efcorlin Allenburys. Hydrocartisone sodium succinate 134mg equivalent to 100mg of hydrocartisone.
Preparetion of Hydrocartisone acetate:
Indications:- Rhumatology:a) intraarticular injection, rheumatoid arthritis, osteoarthritis , gouty arthritis, joint sequelae of fractures and dislocations.
b) Periarticular/soft tissue injection, scapulo humeral periarthritis, periarthritis of hip, bursitis, scapulo humeral periarthritis , tendinitis, Brand name:- wysolone (wyth lederle) 5mg tablet, 10mg tablet, 20mg tablet
preparation of methyl prednesolone:- Indications:- allergic, inflammatory, auto immune disease, malignacies, cerebral oedema, rheumatic diseases.
Dosage:- Adults: Asthma/allergic condition 40-120mg, Dermatological condition 40-120mg. Dosage should be governed by severity of the condition rather than by strict adherence to the ratio indicated by age or body weight. Children: 2-4mg/24 hours, divided every 4-6 hours. Brand name:- cytosine (methyl prednesolone sodium succinate 500mg or 1gm vial.
Trimicinolone: A highly selective glucocorticoid,
Mode of action:- same as corticoids
Special precautions: hyper tension, chronic infection, glaucoma, osteoporosis,congestive cardiac failure, diabetic, myasthenia gravis, psychological disorders.
Indications:- Asthma, allergies disorders rheumatoid arthritis, dermatoses
Dosage:- Adults: oral 8-32 mg daily in single or 4 divided dosage. Injection : 4-32 mg daily in single or divided doses. Intra articular:- 2.5mg-15mg, intradermal 0.2-0.3ml, intramuscular: 40-60mg injected deep in to gluteal muscle, hey fever or pollen asthma: 40-100mg not to be given I.V
children:- 4-12mg below 25kg, Injection; not recommended for children below 6 years.
Preparetion of Trimicinolone:- Brand name: Kenacort (sarabhai) 4mg tablet, amp of 1ml/10mg.
Dexamethasone:- It is selective and very potent glucocorticoid. It causes suppression of pituitary adrenal axis. Mode of action: Same as corticoids. on set of action:- 1-4days. Duration of action: some effects may last several days.
Special Precautions:- Glaucoma,epilepsy, Hypertension, hepatic dysfunction, may reduce response of pituitary adrenal axis to stress.
Indications:- Shock due to trauma, Allergies emergencies overwhelming infections( with specific antibiotics) adrenal crisis, Rheumatoid arthritis, Asthma, Nephritic- syndrome, suppression of inflammation in eye disorders. Dosage:- Adults: 4-20mg repeated as necessary I.M. or I.V. daily dose 80mg. Children: 0.1mg-0.5mg/kg/24 hours
preparations of Dexamethasone: brand name: Cort: 4mg/ml amp of 1ml. Dexona ; tablet of 0.5mg
Betamethasone:- It is more potent than prednesolone.
Mode of action:- same as corticoid
Special precautions:- Diabetic Mellitus, Hyper tension, epilepsy, Glaucoma, peptic ulcers, congestive cardiac failure, may impair ability to resist infection, previous steroid myopathy.
Indications:- status asthmeticus, acute allergies reactions, anaphylactic reaction to drugs. Severe shock arising from surgical or accidental trauma or overwhelming infection, Addison’s disease, Hypopituitarism following adrenalectomy. simmonds disease, tennis elbow, tenosynovitis, and bursitis, Rheumatological disease. Ulcerative colitis, regional enteritis, T.B meningitis, and sub arachnoid bleed.
Dosage: Adults: Initially 0.5-6mg daily. Drug should be withdrawn gradually.
Children:- Fraction of adult dose 25% at 1year, 50% at 7 years, 75% at 12 years.
Preparation of Betamethasone: Brand name: Betnesol tab, 0.5mg tab, Injection 4mg/ml amp of 1ml. 15ml drops 0.5mg/ml
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