corticosteroids

Answer 1

Question: Can you tell me about Fludrocortisone?
Answer:

Class: Mineralocorticoid (Cortisol replacement)

Mechanism:

Mimics aldosterone → increases sodium (Na) absorption and potassium (K) excretion in the distal tubules (DT) and collecting ducts

Increases the expression of Na/K ATPase → greater sodium reabsorption and lower potassium excretion

Use:

Neuropathic postural hypotension

Adrenocortical insufficiency

Side Effects:

Common: Hypokalemia, edema, hypertension, increased risk of infection

Serious: Cushing syndrome, impaired healing, peptic ulcer

Important Note:

Caution in steroid use due to the risk of HPA axis suppression, hypokalemia, and infection

Always monitor for electrolyte disturbances, especially potassium

Answer 2

Question: Can you tell me about Corticosteroids (e.g., Hydrocortisone, Prednisolone, Dexamethasone)?
Answer:

Class: Glucocorticoids

Mechanism:

Glucocorticoids are lipophilic → diffuse through cell membranes and bind to glucocorticoid receptors (GR) in the cytoplasm

Gene modulation: Increases lipocortin-1 production → inhibits phospholipase A2 (PLA2), which reduces the production of inflammatory mediators (prostaglandins and leukotrienes)

Anti-inflammatory effects: Downregulation of pro-inflammatory cytokines, reduced migration of immune cells, inhibition of T-cell proliferation, and stabilization of mast cells

Use:

Anti-inflammatory and immunosuppressive treatment for various conditions, including self-limited conditions (e.g., rhinitis) to life-threatening diseases (e.g., leukemia)

Side Effects:

Metabolic: Cushing’s syndrome

Infections: Increased susceptibility to infections, delayed disease detection

HPA Axis Suppression: Can lead to Addison’s disease if discontinued abruptly

Important Notes:

Minimize use: To reduce HPA suppression, use the lowest dose possible

Avoid abrupt discontinuation in long-term use → risk of steroid withdrawal syndrome

Consider local treatment for conditions where possible

Monitor for side effects, especially metabolic disturbances, infections, and HPA suppression