Corticosteroids: Uses, Mechanism of action, Side effects, Precautions - Be healthy.

Mechanism of action of corticosteroids

It enters the cells and binds with intracellular receptors forming a complex form, this complex enters the nucleus and alters gene expression which in turn affects different organs.

Pharmacological actions corticosteroids

1- Immunosuppressive 

Suppress macrophages, T and B lymphocytes, by this mechanism antibody formation is decreased.

2- Anti-inflammatory

Suppress macrophages and polymorphonuclear leukocytes, by this mechanism the phagocytic activity is reduced.

It stabilizes mast cells and the lysosomal membrane.

It causes decreased capillary permeability and decreases the release of arachidonic acid, prostaglandins, leukotrienes.

3- Metabolic action ( Catabolic hormone )

• Carbohydrates: Hyperglycemia ( It is Diabetogenic )
• Proteins: Muscle wasting and osteoporosis ( It is anti-vitamin D )
• Fat: Hyperlipidemia
• Minerals: Hypernatremia, Hypokalemia, Hypocalcemia, Alkalosis.

Members of corticosteroids

1. Short-acting: Hydrocortisone 
2. Intermediate-acting: Prednisone - Prednisolone
3. Long-acting: Dexamethasone - Betamethasone
4. Inhalation: Betamethasone - Beclomethasone(Low potency)- Fluticasone ( High potency )

Uses of Corticosteroids

• Congenital adrenal hyperplasia
• Adrenal insufficiency [ Addisonian crisis - Chronic adrenal insufficiency ]
• Allergic disorders [ Anaphylactic shock - Bronchial asthma - Skin and mucous membrane allergy ] 
• Organ transplantation
• Leukemia and lymphoma
• Cerebral edema
• Shock [ Bleeding, Anaphylactic shock or septic shock ] 
• Hypercalcemia [ Due to vitamin D toxicity or malignancy ]
• Induction of fetal lung maturation

Side effects and precautions 

1- In fact, Using or taking corticosteroid drugs suppress the secretion of ACTH, this may cause " Adrenal Suppression " which is unfavorable. You can avoid this by:

•  Use in a short duration
•  Intermediate members
•  Give corticosteroid supplement during stress
•  You have to stop it gradually
•  Single morning dose
•  Alternate day therapy 
•  If possible try to take topical form

2- It masks infection signs and causes flaring of the infection. You can avoid this by:

• Use under the umbrella of antibiotics.

3- It causes hyperglycemia so it is " Diabetogenic " and causes hyperlipidemia " Increased triglycerides and cholesterol "

4- It causes cushinoid features: [ Moon face - Truncal obesity - Thin obesity - Thin skin - Hirsutism - Acne ]

5- It causes protein loss and muscle wasting ( Myopathy ) and muscle pains ( Myalgia )

6- Thin skin and delayed wound healing

7- Osteoporosis 

8- Growth retardation 

9- Cataract and glaucoma

10- Peptic ulcer due to decreased secretion of prostaglandins. To avoid this :

• Take it with food ( The form of tablet must be enteric-coated )

11- Hypertension. To avoid this: 

• Monitor your blood pressure
• Decrease your salt intake

12-  Euphoria up to psychosis and depression 

13- Glaucoma and cataract 

14- If taken orally, it may lead to " Oropharyngeal candidiasis "

15- Dysphonia ( It causes voice problems over time )

16- It causes TB infection to spread

Summary 

• Corticosteroids are widely prescribed by doctors as it very potent in its pharmacological actions.
• Corticosteroids adverse effects are too dangerous and bad in the long term, try to avoid them and ask your doctor about if you are getting well or not.
• Before taking any medications or any members of corticosteroids or any combination drugs, talk to your doctor about this drug and ask about the potential side effects and if the drug is beneficial or not in the long term. 
• Any side effects noticed have to be told to your doctor, side effects may be harmful or dangerous so talk to your doctor about them.
• Eat healthy food, and exercise as long as you can, and talk to your doctor about if there is a specific food for you to have or not.  
• Try to get away from stress and be positive.
• Ask your doctor about side medications that you are taking, this is important for you as a combination of drugs may be toxic for you or may not help you getting cure from infections and will no doubt affect your liver and kidney and cause problems with them. So be careful about side drugs that you are taking and tell your doctor about them so your doctor will see if you can complete the regimen or not. Your doctor will see if there are other alternative medications to use or not.