Steroids
Glucocorticoids
- Natural
- Cortisone Acetate
- Hydrocortisone
- 20mg eq, 1 anti inflame potency, 8-12hr, 1/125 mineralocorticoid
- Pregnenolone
- Synthetic
- Cortisol like
- Fludrocortisone (Florinef)
- 1 mineralocorticoid potency
- Methylprednisolone
- 4mg eq, 5 anti inflame, 18-36hrs, no mineralocorticoid
- Prednisolone
- 5mg eq, 4 anti inflame, 18-36hrs, 1/150 mineralocorticoid
- Prednisone
- 5mg eq, 4 anti inflame, 18-36hrs, 1/150 mineralocorticoid
- Methasones
- Alclometasone
- Beclometasone (Qvar)
- Betamethasone
- Clobetasol
- Clobetasone
- Dexamethasone
- 0.75mg eq, 25-50 anti inflame, 36-54hrs, no mineralocorticoid
- Fluticasone
- Mometasone
- Triamcinolone
- Cyclic Ketals
- Anti-glucocorticoids
- Antagonists
- Aglepristone
- Ketoconazole
- Mifepristone
- Ulipristal Acetate
- Synthesis modifiers
- Ketoconazole
- Muscle Relaxants
- Succinylcholine
- CI: Burns, Neuromuscular Disease/Paraplegia, Eye Trauma, Raised ICP
- Anesthetic Induction Agents
- Propofol, Midazolam, Sodium Thiopental
- Steroids
- Cushings, Sodium retention/K+ wasting (hypertension), osteopenia, ischemic bone necrosis, myopathy
- Cancer Drugs
- Calcineurin Inhibitors
- block T cell activation by preventing IL-2 Transcription
- Cyclosporine and Tacrolimus
- Highly Nephrotoxic
- Sirolimus (Rapamycin)
- Not nephrotoxic
Glucocorticoid Cessation
- Indications
- Therapeutic benefit achieved
- Uncontrolled SE (hypertension)
- Severe complications (psychosis)
- Risks
- Adrenal insufficiency from HPA axis suppression
- When to taper
- ≥3 weeks of daily use
- Cushingoid appearance