Reactions Of Corticosteroids

Reactions Of Corticosteroids

Write Important Uses, Side Effects, And Contraindications, If Any, Of Glucocorticoids.
Or
Write Short Note On the Therapeutic Uses And Adverse Reactions Of Corticosteroids.
Answer:

Uses Of Corticosteroids

1. Endocrine 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 progression 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 of 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 a life-saving treatment in Stevens-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.

Corticosteroids Drugs

Side Effects of Corticosteroids 

• Cushing’s habitus: Abnormal fat distribution which leads to a characteristic appearance with a rounded face, narrow mouth, supraclavicular hump, obesity of the trunk with relatively thin limbs.
• The fragile skin and purple striae: Present typically on thighs and lower abdomen, easy bruising, telangiectasis, hirsutism. Cutaneous atrophy localized to the site occurs with topical application as well.
• Hyperglycemia: It may be glycosuria or the precipitation of diabetes.
• Muscular weakness: Proximal (shoulder, arm, pelvis, thigh) muscles are primarily affected. Myopathy occurs occasionally and warrants withdrawal of the corticoids.
• Susceptibility to infection: Long-term therapy with steroids leads to the reactivation of opportunistic infections like viral, fungal, and bacterial.
• Delayed healing: There is delayed healing of wounds and surgical incisions.
• Peptic ulceration: Risk is doubled; bleeding and silent perforation of ulcers may occur. Dyspeptic symptoms are frequent with high-dose therapy.
• Osteoporosis: Especially involving vertebrae and other flat spongy bones. Compression fractures of vertebrae and spontaneous fractures of long bones can occur, especially in the elderly.
• Avascular necrosis: Avascular necrosis of the head of the femur, humerus, or knee joint is an occasional, abrupt-onset complication of high-dose corticosteroid therapy.
• Eye: Posterior subcapsular cataracts may develop after several years of use, especially in children. Glaucoma may develop in susceptible individuals after prolonged topical therapy.
• Growth retardation: It occurs in children even with small doses if given for long periods. Large doses do inhibit growth hormone secretion, but growth retardation may, in addition, be a direct cellular effect of corticoids. Recombinant growth hormone given concurrently can prevent growth retardation, but the risk/benefit of such use is not known.
• Psychiatric disturbances: The presence of mild euphoria frequently accompanies high-dose steroid treatment. This may rarely progress to manic psychosis. Nervousness, decreased sleep, and mood changes occur in some patients. Rarely is a depressive illness induced after long-term use.
• Suppression of hypothalamo—pituitary—adrenal (HPA) axis: This occurs depending on both the dose and duration of therapy. In time, the adrenal cortex atrophies, and the stoppage of exogenous steroids precipitates withdrawal syndrome consisting of malaise, fever, anorexia, nausea, postural hypotension, electrolyte imbalance, weakness, pain in muscles and joints, and reactivation of the disease for which they were used. Subjected to stress, these patients may go into acute adrenal insufficiency, leading to cardiovascular collapse.

Contraindications Of Corticosteroids

• Peptic ulcer: By providing the therapy, glucocorticoids cause bleeding and silent perforation of the ulcer
• Diabetes mellitus: Diabetes mellitus causes the precipitation of diabetes.
• Viral and fungal infections: 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.