Systemic steroids

Which steroids are used to treat adrenal hormonal replacement due to having more glucocorticoid activity

Hydrocortisone

Cortisone

Prednisolone

What is fludrocortisone used to treat

Addison's disease

Orthostatic hypertension

What does fludrocortisone mimic

Aldosterone

What can systemic steroids cause

Adrenal gland to stop producing cortisol which is the suppression of the hypothalamic pituitary adrenal axis

What causes Cushing Syndrome

The adrenal gland produces too much cortisol or if exogenous steroids are taken is doses too high

Which disease is the opposite of Cushing Syndrome

Addison's

What causes Addison's disease

Adrenal gland does not make enough cortisol

What is Addisonian crisis

Fatal adrenal crisis when exogenous steroids are suddenly stopped

Ways to reduce systemic steroid risks

Every other day dosing

Joint inflammation: intra-articular injections

GI conditions: low systemic absorption steroid

Asthma: inhaled steroids

Long term steroid use: use lowest dose for shortest duration

Features of Cushing Syndrome

Psychiatric changes

Moon fac

Hirsutism

Muscle wasting

Striae

Hypertension

Osteoporosis

Obese

Dorsocervical fat pad

Steroids least to most potent phrase

Cute Helpful Pharmacists and Physicians Marry Together and Deliver Babies

Steroids least to most potent

Cortisone

Hydrocortisone

Prednisone

Prednisolone

Methylprednisone

Triamcinolone

Dexamethasone

Betamethasone

Short acting steroids

Hydrocortisone

Cortisone

Intermediate acting steroids

Prednisone

Prednisolone

Methyprednisone

Triamcinolone

Long acting and highest potency steroids

Dexamethasone

Betamethasone

Steroid dose equivalence Cortisone and hydrocortisone

25 mg

20 mg

Steroid dose equivalence Prednisone and Prednisolone

5 mg

5 mg

Steroid dose equivalence Methylprednisolone and Triamcinolone

4 mg

4 mg

Steroid dose equivalence Dexamethasone and Betamethasone

0.75 mg

0.6 mg

Dexamethasone brand

Decadron

Hydrocortisone brand

Solu-Cortef

Methylprednisone brand

Medrol

Solu-medrol

Prednisolone brand

Orapred ODT

Triamcinolone brand

Kenalog

Administration of glucocorticoids

Take oral doses with food to avoid GI upset

Glucocorticoid warnings

Adrenal suppression: if used > 14 days must taper

Glucocorticoid short term side effects

Fluid retention

Stomach upset

Emotional instability

Insomnia

Increase appetite and weight gain

Acute increase in BP and BG

Glucocorticoid long term side effects

Increased cholesterol (TG and LDL)

S/sx of Cushing Syndrome

Prodrug of cortisol

Cortisone

Prodrug of prednisolone

Prednisone

How long is a Medrol pack

6 days

When is a person immunosuppressed from glucocorticoid

>= 2 mg/kg/day or >= 20 mg/day of prednisone or prednisolone equivalent