Steroids such as corticosteroids are potent anti-inflammatory drugs that are used to treat conditions like acute inflammation and allergic reactions, though they can cause side effects like increased fat redistribution and risk of infection; other anti-inflammatory drugs include inhaled corticosteroids like beclomethasone and fluticasone to prevent airway inflammation, as well as leukotriene inhibitors and cromolyn sodium which are also used to prevent airway inflammation with fewer side effects than steroids.
5. Steroid Side Effects: “Cushing’s
Syndrome”
Gluconeogenesis
Osteoporosis Increased gastric acidity
Physical changes Decreased resistance to
– Increased fat production and infection
redistribution – MDI may cause candida
– Acne albicans, “thrush”
– Hirsutism – Patients need to rinse mouth
– Fragile skin after MDI
Sodium retention Dependency
– Fluid retention – Both physical and
– Potassium loss and metabolic psychological
alkalosis • Patients may need to be
weaned from steroid therapy
6. Interaction with other drugs
Increased breakdown in the presence of:
– Dilantin, barbiturates, certain tranquilizers, anti-
histamines, ephedrine
Decreased breakdown (and greater chance of
severe side effects) in the presence of some
antibiotics, eg erythromycin
7. Steroids in Respiratory Care
For prevention of inflammation – aerosol
For relief of inflammation: systemic
9. Prednisone (Prednisolone)
Brand: Deltasone, Delta-Cortef
4X as potent as hydrocortisone
Given orally
– Side effects minimized if given every other day
– Patient’s usually need to be weaned from it
16. Fluticasone
Brand: Flovent
MDI (similar to Flunisolide)
Fluticasone is also sold as a combo drug,
Advair, which contains fluticasone and
salmeterol
– Taken as a dry powder inhaler (DPI)
19. Cromolyn Sodium
Brands: Intal, Aarane
Is a mast cell stabilizer so used to prevent airway
inflammation
– Does not relieve airway inflammation!
Often used as an alternative to aerosol steroids in
children
Administered via Spinhaler (DPI), MDI, nebulizer
– Usually needs to be administered Q.I.D.
– May take at least two weeks before any effects are seen
21. NSAIDs: Leukotriene Inhibitors
(used to prevent airway inflammation)
Zafirlukast (Accolate)
– Taken as a pill B.I.D.
Zileuton (Zyflo)
– Taken as a pill Q.I.D.
Montelukast (Singulair)
– Taken as a pill just once a day
22. NSAIDs: Omalizumab (Xolair)
Genetically engineered recombinant humanized
monoclonal antibody
Binds to IgE and prevents it from attaching to
mast cells
Given sub-Q 1-2 times per month