Adrenocorticosteroid Drugs

Adrenocorticosteroid Drugs

Enumerate Important Indications And Contraindications Of Adrenocorticosteroids.
Answer:

The following are the therapeutic uses of glucocorticoids:

1. Endocrinal uses.

• Replacement therapy
  • Acute adrenal insufficiency: Since it is a medical emergency that occurs due to infection or due to sudden withdrawal of steroids, it is treated with IV hydrocortisone hemisuccinate 100 mg bolus.
  • Chronic adrenal insufficiency or Addison’s disease: This condition is treated by oral hydrocortisone 20 to 40 mg daily along with adequate salt and water.

2. Non-endocrinal uses.

• Rheumatoid arthritis: It provides immediate relief in rheumatoid arthritis but does not stop the progress of the disease. The steroid is given along with NSAIDs. If one or two joints are involved intra-articular injection is given.
• Osteoarthritis: In the acute form of the disease intra-articular injection is given.
• Rheumatic fever: Glucocorticoids provide more symptomatic relief and are indicated in cases with carditis and congestive cardiac failure.
• Gout: Glucocorticoids are used in cases with acute gout when NSAIDs don’t work.
• Allergic conditions: Glucocorticoids suppress allergic conditions such as hay fever, drug reactions, urticaria, contact dermatitis, angioneurotic edema, and anaphylaxis. Glucocorticoids are slow-acting drugs in these allergic conditions.
• Bronchial asthma: In acute status asthmaticus, IV hydrocortisone is given. In chronic asthma, inhalational preparations such as beclomethasone, and budesonide should be given.
• Collagen diseases: In collagen diseases such as polyarteritis nodosa, dermatomyositis, etc. large doses of glucocorticoids provide good relief.
• Renal disease: Glucocorticoids act as first-line drugs in nephrotic syndrome.
• Eye diseases: Corticosteroids are used in many inflammatory ocular diseases and prevent damage to vision.
• Dermatological diseases: Topical glucocorticoids provide relief from the itching, pain, and inflammation of various dermatological diseases. Systemic steroidal therapy acts as life-saving in Steven Johnson syndrome, Pemphigus vulgaris, etc.
• Hematological diseases: Glucocorticoids have good control over autoimmune hemolytic anemias. Since glucocorticoids provide lymphocytic action they are indicated in various malignancies, leukemias, and Hodgkin’s disease.
• Cerebral edema: Dexamethasone has the mechanism of not retaining salt and water, so it is the first choice of steroid in cerebral edema.
• Gastrointestinal diseases: Methylprednisolone is used in severe cases.
• Lung diseases: Glucocorticoids are useful in the treatment of aspiration pneumonia and infant respiratory distress syndrome.
• Shock: In septic shock IV glucocorticosteroids are given as life-saving drugs.
• Organ transplantation: Glucocorticoids are useful to treat and prevent graft rejection. Other uses of corticosteroids are in Bell’s palsy, myotonia, and acute polyneuritis.

Contraindications Of Adrenocorticosteroids

• Peptic ulcer: By providing the therapy glucocorticoid causes bleeding and silent perforation of the ulcer
• Diabetes mellitus: In diabetes mellitus, they cause the precipitation of diabetes.
• Viral and fungal infection: During viral and fungal infections they increase susceptibility towards infection.
• Osteoporosis: Compression fractures of vertebrae and spontaneous fractures of long bones can occur.
• Psychosis: They cause psychiatric disturbances and hence produce mild euphoria.
• Herpes simplex keratitis: Posterior subcapsular cataract may develop.
• Corticosteroids are contraindicated in various other diseases such as hypertension, tuberculosis, epilepsy, congestive cardiac failure, renal failure, and glaucoma.