Steroids: Pharmacology, Difficulties and Practice Delivery Issues
DOI:
https://doi.org/10.22270/ijmspr.v8i3.60Keywords:
Steroids, Corticosteroids, Adrenal cortex hormones, Glucocorticoids, Medication therapy management, MineralocorticoidsAbstract
Since their identification nearly 80 years ago, steroids have played a prominent role in the treatment of many disease states. Many of the clinical roles of steroids are related to their potent anti-inflammatory and immune-modulating properties. Clinically relevant side effects of steroids are common and problematic. Side effects can occur at a wide range of doses and vary depending on the route of administration. The full spectrum of side effects can be present even in patients taking low doses. Practitioners must be aware that these drugs might exacerbate a preexisting condition or present a new medical condition. Knowledge of the clinical implications of prescribing these agents is critical. Steroid withdrawal syndrome can produce a broad array of signs and symptoms, some of which are not well recognized. High fever is among these. Corticosteroids modulate immune function through various effects in the nucleus of numerous cells. When used in pharmacologic doses to suppress allergic responses or inflammation, these agents can cause numerous adverse effects associated with an excess of glucocorticoid activity. Prolonged use (>2 wk) results in suppression of the hypothalamic-pituitary-adrenal axis, which requires tapering of doses. Dosing strategies for systemic corticosteroids are designed to minimize the risk for hypothalamic pituitary-adrenal axis suppression. This review summarizes the basic pharmacology, complications, and practice delivery issues regarding steroids.
Keywords: Steroids, Corticosteroids, Adrenal cortex hormones, Glucocorticoids, Medication therapy management, Mineralocorticoids
References
Kendall, EC. Nobel lecture: The development of cortisone as a therapeutic agent. Nobelprize.org. December 11, 1950. https:// www.nobelprize.org/nobel_prizes/medicine/laureates/1950/ kendall-lecture.html.
Stewart PM, Krone NP. The adrenal cortex. In: Melmed S, Polonsky K, Larsen PR, Kronenberg H, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Saunders; 2011.
Baeck M, Marot L, Nicolas JF, Pilette C, Tennstedt D, Goossens A. Allergic hypersensitivity to topical and systemic corticosteroids: a review. Allergy. 2009; 64(7):978-94. https://doi.org/10.1111/j.1398-9995.2009.02038.x
Roth P, Happold C, Weller M. Corticosteroid use in neuro-oncology: an update. Neuro-oncology practice. 2015; 2(1):6-12. https://doi.org/10.1093/nop/npu029
Williams DM. Clinical pharmacology of corticosteroids. Respiratory care. 2018; 63(6):655-70. https://doi.org/10.4187/respcare.06314
Gupta P, Bhatia V. Corticosteroid physiology and principles of therapy. Indian J Pediatr. 2008; 75(10):1039-1044. https://doi.org/10.1007/s12098-008-0208-1
Shaikh S, Verma H, Yadav M, Jauhari M, Bullangowda J, Applications of steroid in clinical practice: a review. ISRN Anesthesiol. 2012; 985495. https://doi.org/10.5402/2012/985495
Becker DE. Basic and clinical pharmacology of glucocorticosteroids. Anesth Prog. 2013; 60(1):25-31. https://doi.org/10.2344/0003-3006-60.1.25
Annane D. Adrenal insufficiency in sepsis. Curr Pharm Des. 2008; 14(19):1882-1886. https://doi.org/10.2174/138161208784980626
Xu J, Winkler J, Derendorf H. A pharmacokinetic/pharmacodynamic approach to predict total prednisolone concentrations in human plasma. J Pharmacokinet Pharmacodyn. 2007; 34(3):355-372. https://doi.org/10.1007/s10928-007-9050-8
Curtis JR, Westfall AO, Allison J, et al. Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis Rheum. 2006; 55(3):420-426. https://doi.org/10.1002/art.21984
Kenna HA, Poon AW, de los Angeles CP, Koran LM. Psychiatric complications of treatment with corticosteroids: review with case report. Psychiatry Clin Neurosci. 2011; 65(6):549-560. https://doi.org/10.1111/j.1440-1819.2011.02260.x
Warrington TP, Bostwick JM. Psychiatric adverse effects of corticosteroids. Mayo Clin Proc. 2006; 81(10):1361-1367. https://doi.org/10.4065/81.10.1361
Patten SB, Neutel CI. Corticosteroid-induced adverse psychiatric effects: incidence, diagnosis and management. Drug Saf. 2000; 22(2):111-122. https://doi.org/10.2165/00002018-200022020-00004
Pereira RM, Carvalho JF, Canalis E. Glucocorticoid-induced osteoporosis in rheumatic diseases. Clinics (Sao Paulo). 2010; 65(11):1197-1205. https://doi.org/10.1590/S1807-59322010001100024
Lansang MC, Hustak LK. Glucocorticoid-induced diabetes and adrenal suppression: how to detect and manage them. Cleve Clin J Med. 2011; 78(11):748-756. https://doi.org/10.3949/ccjm.78a.10180
Leuppi JD, Schuetz P, Bingisser R, Bodmer M, Briel M, Drescher T, et al. Shortterm vs conventional glucocorticoid therapy in acute exacerbations of COPD: The REDUCE randomized clinical trial. JAMA 2013; 309(21):2223-2231. https://doi.org/10.1001/jama.2013.5023
Jain M, Jain A, Khare B, Jain DK, Khan R, Jain D. An Update on the Recent Emergence of Candida auris. Asian Journal of Dental and Health Sciences. 2022; 2(1):14-9. https://doi.org/10.22270/ajdhs.v2i1.11
Benzon HT, Gissen AJ, Strichartz GR, Avram MJ, Covino BG. The effect of polyethylene glycol on mammalian nerve impulses. Anesth Analg. 1987; 66(6):553-559. https://doi.org/10.1213/00000539-198706000-00012
Craig DB, Habib GG. Flaccid paraparesis following obstetrical epidural anesthesia: possible role of benzyl alcohol. Anesth Analg. 1977; 56(2):219-221. https://doi.org/10.1213/00000539-197703000-00011
Ahadian FM, McGreevy K, Schulteis G. Lumbar transforaminal epidural dexamethasone: a prospective, randomized, doubleblind, dose-response trial. Reg Anesth Pain Med. 2011; 36(6):572-578. https://doi.org/10.1097/AAP.0b013e318232e843
Dreyfuss P, Baker R, Bogduk N. Comparative effectiveness of cervical transforaminal injections with particulate and nonparticulate corticosteroid preparations for cervical radicular pain. Pain Med. 2006; 7(3):237-242. https://doi.org/10.1111/j.1526-4637.2006.00162.x
Somayaji HS, Saifuddin A, Casey AT, Briggs TW. Spinal cord infarction following therapeutic computed tomography-guided left L2 nerve root injection. Spine (Phila Pa 1976). 2005; 30(4):E106-E108. https://doi.org/10.1097/01.brs.0000153400.67526.07
Aleem A, Kabir H, Review on Swertia chirata as traditional uses to its pyhtochemistry and phrmacological activity, Journal of Drug Delivery and Therapeutics 2018; 8(5-s):73-78 https://doi.org/10.22270/jddt.v8i5-s.1957
Morley KW, Dinulos JG. Update on topical glucocorticoid use in children. Curr Opin Pediatr. 2012; 24(1):121-128. https://doi.org/10.1097/MOP.0b013e32834ef53d
Jat D, Thakur N, Jain DK, Prasad S, Yadav R. Iris ensata Thunb: Review on Its Chemistry, Morphology, Ethno Medical Uses, Phytochemistry and Pharmacological Activities. Asian Journal of Dental and Health Sciences. 2022; 2(1):1-6. https://doi.org/10.22270/ajdhs.v2i1.9
Doherty DE, Tashkin DP, Kerwin E, et al. Effects of mometasone furoate/formoterol fumarate fixed-dose combination formulation on chronic obstructive pulmonary disease (COPD): results from a 52-week Phase III trial in subjects with moderate-to-very severe COPD. Int J Chron Obstruct Pulmon Dis. 2012; 7:57-71. https://doi.org/10.2147/COPD.S27320
Taplin CE, Cowell CT, Silink M, Ambler GR. Fludrocortisone therapy in cerebral salt wasting. Pediatrics. 2006; 118(6): e1904-e1908. https://doi.org/10.1542/peds.2006-0702
Freitas J, Santos R, Azevedo E, Costa O, Carvalho M, de Freitas AF. Clinical improvement in patients with orthostatic intolerance after treatment with bisoprolol and fludrocortisone. Clin Auton Res. 2000; 10(5):293-299. https://doi.org/10.1007/BF02281112
Physicians Total Care, Inc. Fludrocortisone acetate tablet. Daily Med. September 2010. https://dailymed.nlm.nih.gov/dailymed/ lookup.cfm?setid¼bf927cd9-1891-4de4-b4be-743a26363a64.
Wallner BP, Mattaliano RJ, Hession C, et al. Cloning and expression of human lipocortin, a phospholipase A2 inhibitor with potential anti-inflammatory activity. Nature. 1986; 320(6057):77-81. https://doi.org/10.1038/320077a0
Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids-new mechanisms for old drugs. N Engl J Med. 2005; 353(16):1711-1723. https://doi.org/10.1056/NEJMra050541
Blackwell GJ, Carnuccio R, Di Rosa M, Flower RJ, Parente L, Persico P. Macrocortin: a polypeptide causing the antiphospholipase effect of glucocorticoids. Nature. 1980; 287(5778):147-149. https://doi.org/10.1038/287147a0
Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. N Engl J Med. 2003; 348(8):727-734. https://doi.org/10.1056/NEJMra020529
Williams DM. Clinical pharmacology of corticosteroids. Respiratory care. 2018; 63(6):655-70. https://doi.org/10.4187/respcare.06314
Lakshmi Surekha K, Naveen Reddy P, Rasajna G. Bhavani B. A Review on Corticosteroids and Its Clinical Complications on Long Term Exposure. International Journal of Advanced Scientific Research and Management. 2020; 5(9):34-38 https://doi.org/10.36282/IJASRM/5.9.2020.1746
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