2. INTRODUCTION
• Corticosteroids are a class of steroid
hormones that are produced in the
adrenal cortex.
• Corticosteroids includes natural
glucocorticoids and mineralocorticoids,
and their synthetic analogues.
3. Functions of Steroids
• Stress response
• Immune response
• Regulation of inflammation
• Carbohydrate metabolism
• Protein catabolism
• Blood electrolyte level maintenance
• Control of behavior
4. Biosynthesis
• Synthesis of steroids are from adrenal cortical
cells from cholesterol.
• Adrenal cortex is divided into three zones
– Zona glomerulosa – mineralocorticoids such as
aldosterone, which regulates sodium and water are
produced.
– Zona fasiculata – glucocorticoids such as
hydrocortisone and corticosterone, which regulates
carbohydrate and protein metabolism and Na+ &
H20 balance are produced.
5. Biosynthesis (Cont..)
– Zona reticularis– involved in the biosynthesis of
androgens.
STEROIDS CLASSIFICATIONS
Mineralocorticoids (Cortisone, Fludrocortisone)
Glucocorticoids (Betamethasone,
Methylprednisolone)
Sex Steroids (Estrogen, Progestins)
6. MECHANISM OF
ACTION• Steroids in blood binds to transcortin
• Glucocorticods molecules binds to
cytoplasmic receptor protein
• Structural changes occurs in receptor
steroid Complex
• Migration of steroid complex into nucleus
7. MECHANISM OF ACTION
• Binding of glucocorticoid response
elements on the chromatin.
• Suppression of genes
• Genes inhibition contributes to their anti-
inflammatory & Immunosuppressive
action.
8. PHARMACOLOGIC ACTION
• Carbohydrate and Protein Metabolism
• Fat Metabolism – promotes lipolysis
• Calcium metabolism & water excretion
• Cardiovascular – permissive effects
• Skeletal muscles – weakness in case of hypo
and hypercorticism
• CNS – Precipitates seizure in epileptic patients.
• Stomach – increased secretion of gastric acid
and pepsin.
9. PHARMACOLOGIC ACTION
• Hemopoitic System - ↑se in number of
RBC’s & Platelets, but decrease in
lymphocytes, eosinophills and basophils.
• Inflammatory Response– reduction of
phagocytic activity.
• Immunologic and allergic response –
Suppresses all types of allergic phenomenon
and hypersensitization.
10. Pharmacokinetics
• Absorption – effective in oral route, acts rapidly
by IV / IM.
• Bioavailability – oral bioavailability of synthetic
corticosteroids are high.
• Plasma protein binding is 90 %.
• Metabolism by hepatic microsomal enzymes.
• Excretion – urine
• Distribution – widely distributed – 10L/Kg
• Plasma t ½ - 66 minutes.
11. Preparations & Doses
• Synthetic steroids have largely replaced the
natural compounds in therapeutic use
because they are potent, longer acting and
more selective for glucocorticoid /
mineralocorticoid actions.
13. Doses & Routes
(Glucocorticoids)
Category Compound
Short Acting (t1/2 <12h) Hydrocortisone (cortisol) 20 mg, 100 mg
Oral, IV
Intermediate acting (t1/2 12 – 36 h) Prednisolone 5 – 60 mg / day oral, IM
Methylprednisolone 4 – 32 mg, Oral, IV
Long acting (t1/2 > 36 h) Dexamethasone 0.5 – 5 mg / day oral,
IV, IM
Betamethasone 0.5 – 5 mg / day oral,
IV, IM
14. Doses & Routes
(Mineralocorticoids)
Category Compound
Mineralocorticoids Desoxycortisone 2 – 5 mg once or twice
weekly, sublingual, IM
Aldosterone
(Aldosterone is not used clinically)
17. ADVERSE EFFECTS
• Occurs usually with prolonged therapy
• Mineralocorticoids
• Na and water retention, edema,
hypokalemic alkalosis and HTN.
• Glucocorticoids
• Cushing habitus – Characterized by moon
like face, accumulation of fat in the truncal
region.
18. ADVERSE EFFECTS
• Glucocorticoids
• Hyperglycemia and Glycosuria
• Myopathy & Muscle
• Susceptibility to infections
• Peptic ulceration
• Osteoporosis
• Glaucoma
• Growth retardation in children
• Fetal abnormality (IUGR)
19. NURSES ROLE
• Check vital signs, lung sounds, BP and
weight.
• Conduct MSE, to assess for depression,
withdrawal, Insomnia and anorexia.
• Advise regular opthalmic examination
• Check stool for occult blood periodically.
• Administer suitable antibiotics as
prescribed.
•
21. DEFINITION
• These are androgens with anabolic
properties and are rarely prescribed., but
are commonly abused by athletes in an
attempt to enhance performance.
• They are developed in replace of androgens.
22. MECHANISM OF
ACTION
• Testosterone is converted to active metabolite
dihydrotestosterone
• Increased synthesis of RNA & Cellular protein
• Stimulate growth of muscle, bone, skin and
hair and accelerate closure of epiphyses at ends
of long bones. (↑ed the RBC production)
23. • Indications
– Growth and development retardation.
– Ulcerative colitis
– Osteoporosis
– Aplastic anemia
– After trauma & surgery
– Prolonged immobilization
• Contra Indications
• Pregnancy, Lactation, CHF, Renal failure,
Liver failure and prostate enlargement.
24. • Adverse Effects
• Hepatotoxicity
• Hepatitis B & C
• Abusers of anabolic steroids use same needles so risk of
HIV / AIDS.
• Nurses Role
• Do not administer for more than 90 days.
• Assess the client for Liver function edema, weight gain
and skin changes
• Evaluate the client for signs of depression.
• Warm and shake vials before administer to prevent
crystals. Administer in deep into gluteal muscles
