Pharm - 3. Steroids

The component of the Adrenal gland that secretes steroids

Cortex

The layers of the Cortex and the steroids they secrete

Zona glomerulosa → Mineralocorticoids

Zona fasciculata → Glucocorticoids

Zona reticularis → Androgens

Physiological functions of steroids

- Increase blood glucose

- Increase sodium and water retention

- Suppress (down-regulate) immune response

2 major types of Exogenous Corticosteroids

1) Glucocorticoids

2) Mineralcorticoids

- Glucocorticoids are ______________

- This is an example

- Anti-inflammatory

- Dexamethasone

- Mineral corticosteroids are used for...

- Example

- Sodium and water retention

- Hydrocortisone

- Mineralocorticoids have ______-like effects

- What does this include

- Aldosterone

- Sodium/water retention, increase in BP

Anti-Inflammatory effects of steroids is due to inhibition of these components...

- Lymphocyte proliferation (T and B cells)

- Interleukin production

- Capillary permeability to neutrophils

- Prostaglandin formation

Steroid with the lowest and highest inflammatory effects

Lowest: Cortisone

Highest: Dexamethasone

- Different systemic administration of steroids

- Different topical/local administration of steroids

- PO, IV, IM

- Cream, gel, inhalation, ophthalmic, otic, suppository

- Indication for Steroids

- Although it is not required, name some

- Autoimmune diseases

- Rheumatoid arthritis, Sjogren's syndrome, Post-transplant

One indication for steroids that is applicable to us as dentists

Reduce inflammation after removal of third molars

- Another indication for steroids is when a patient has undergone this treatment prior to coming into your office

- This is usually what disease they have

- Chemotherapy or radiation

- Mucositis

- What should you use specifically to treat Mucositis from chemo

- Specific examples

- Topical solution in combination with antifungal, antihistamine, and local anesthetic

- Hydrocortisone, nystatin, diphenhydramine, lidocaine, aluminum/magnesium hydroxide

Cardiovascular steroids ADR (Adverse drug reactions)

- Hypertension (Cardiovascular)

Infection steroids ADR

- Infections due to immune suppression

GI Steroids ADR

- Gastrointestinal perforations

- Oropharyngeal and esophageal candidiasis

- Peptic ulcer disease

- Infections due to steroid use are due to dosage of...

- Gastrointestinal perforations due to steroid use are due to dosage of...

- Peptic ulcer disease due to steroid use are due to dosage of...

- 20-40 mg/day (700 mg)

- 20-60 mg/day

- 1000 mg

- Steroids can lead to the stimulation of ________ and the inhibition of _______. This leads to ________.

osteoclasts, osteoblasts, Osteoporosis

Even ______ steroids can cause Osteoporosis

inhaled

For prevention of Corticosteroid-induced Osteoporosis, these supplements are prescribed to patients

Calcium and Vit D

Ophthalmic Steroids ADR

- Glaucoma

- Cataracts

General cause of Glaucoma

Increased intraocular pressure

- Glaucoma is most commonly associated with these steroids

- Moderately associated with...

- Least common with...

- Betamethasone and Dexamethasone

- Prednisone

- Hydrocortisone

Glaucoma is _______ except for _________ damage

reversible, optic nerve

"Opacification of the lens"

Cataracts

Is cataracts reversible or irreversible?

irreversible

Dermatological Steroid ADRs

- Acne

- Cutaneous and subcutaneous atrophy

- Delayed wound healing

- Mycosis

High doses of steroids over a long period of time also cause this disease that results in the redistribution of fat

Cushing syndrome

Cushing syndrome symptoms

- Dorsocervical & supraclavicular

- Moon facing

- Central obesity

- Poor wound healing

- Easily bruising

- Hypertension