← All decks
Dermatology
Glucocorticoids
Built from Dermatology, 5th Edition
What’s inside
11 sections · 115 slides
Overview
- Scope of this topic
History and Basic Pharmacology
From the 1950 Nobel Prize to the chemistry that makes a glucocorticoid active
- History of glucocorticoid use in medicine
- Basic chemical structure of glucocorticoids
- Chemical structure of cortisol (hydrocortisone)
- Active drugs need a hydroxyl group, not a ketone
- What the pharmacology table compares
- Pharmacology of systemic glucocorticoids (GCs).
- Duration of action shapes drug choice
- Oral absorption and plasma protein binding
HPA Axis and Molecular Mechanism
The body's own cortisol control system, and how the drug switches genes on and off
- What the HPA axis is
- Three ways cortisol production is controlled
- Free glucocorticoid enters the cell
- Mechanisms of glucocorticoid action
- How glucocorticoids switch genes on and off
- What glucocorticoids shut down in inflammation
- Anti-inflammatory effects of glucocorticoids.
- Effects on white blood cells
Routes of Administration in Dermatology
Choosing oral, intramuscular, intravenous, topical, or intralesional therapy
- Major dermatologic uses of systemic glucocorticoids
- Major uses of systemic glucocorticoids in dermatology.
- Major uses of systemic glucocorticoids in dermatology. (continued)
- Oral therapy - dosing basics
- Split dosing and drug choice for oral therapy
- Intramuscular glucocorticoid therapy
- Intravenous and pulse glucocorticoid therapy
- Topical glucocorticoid potency classes
- Ultra high (super-potent) - WHO class 1
- Ultra high (super-potent) - WHO class 1 (continued)
- High potency - WHO class 2
- High potency - WHO class 2 (continued)
- High potency - WHO class 3
- Moderate potency - WHO class 4
- Moderate potency - WHO class 4 (continued)
- Moderate potency - WHO class 5
- Moderate potency - WHO class 5 (continued)
- Low potency - WHO class 6
- Low potency - WHO class 7
- How the vehicle changes potency
- Avoiding side effects with topical therapy
- Ophthalmic (eye) glucocorticoid preparations
- Ophthalmic glucocorticoids.
- Intralesional glucocorticoid injections
HPA Suppression, Tapering, and Contraindications
How to dose, taper, and test the adrenal axis without harming the patient
- How exogenous glucocorticoids suppress the HPA axis
- Symptoms and risks of adrenal insufficiency
- Glucocorticoid withdrawal syndrome
- Testing the HPA axis
- When to taper systemic glucocorticoids
- How fast to taper, by dose range
- Alternate-morning dosing
- Alternate-morning glucocorticoid therapy.
- Contraindications to glucocorticoid therapy
Overview of Adverse Effects
Short-term versus long-term toxicity, and who is at higher risk
- Short-term versus long-term side effects
- Side effects of short-term systemic glucocorticoid therapy.
- Categories of long-term glucocorticoid toxicity
- Major side effects of long-term systemic glucocorticoid therapy.
- Major side effects of long-term systemic glucocorticoid therapy. (continued)
- Major side effects of long-term systemic glucocorticoid therapy. (continued)
- Major side effects of long-term systemic glucocorticoid therapy. (continued)
- Patients at higher risk for glucocorticoid toxicity
- Patients at higher risk for toxicity from glucocorticoid (GC) therapy.
Musculoskeletal and Bone Complications
Osteoporosis, osteonecrosis, growth suppression, and steroid myopathy
- Osteoporosis - how common and how fast
- Why glucocorticoids weaken bone
- Radiograph showing severe bone demineralization
- Diagnosing osteoporosis
- Prevention and treatment algorithm for glucocorticoid-induced osteoporosis
- Estimating osteoporotic fracture risk with long-term glucocorticoid therapy
- Medications for glucocorticoid-induced osteoporosis
- Other bone-protective drug options
- Osteonecrosis (avascular necrosis)
- Osteonecrosis of the femoral head
- Diagnosing and treating osteonecrosis
- Growth suppression in children
- Glucocorticoid-related myopathy vs true myositis
- Myopathy vs myositis: setting, symptoms, and labs
- Myopathy vs myositis: EMG, MRI, and biopsy
Eye, Metabolic, Cardiovascular, and GI Effects
Cataracts, blood sugar and lipid changes, blood pressure, and the gut
- Cataracts
- Cataract in a child treated with systemic glucocorticoids
- Metabolic effects - blood sugar and lipids
- Other metabolic and body-composition changes
- Cardiovascular effects
- Gastrointestinal effects
- Other GI effects
Infection and Reproductive Effects
Susceptibility to infection, vaccine timing, and pregnancy or fertility considerations
- Increased susceptibility to infection
- Screening for tuberculosis and Pneumocystis pneumonia
- Vaccination precautions
- Obstetric and gynecologic effects
- Menstrual and fertility effects
Neuropsychiatric and Cutaneous Effects
Mood and cognitive change, and the skin's own visible signature of glucocorticoid use
- Mood and cognitive effects ('steroid psychosis')
- Risk factors and management of neuropsychiatric effects
- Pseudotumor cerebri and seizures
- Cutaneous effects overview
- Extensive striae from chronic oral prednisone therapy
- Striae in a second patient on chronic prednisone therapy
- Cutaneous atrophy from topical glucocorticoids
- Cutaneous atrophy from chronic topical glucocorticoid use
- Local side effects of intralesional glucocorticoids
- Glucocorticoid-induced acne and eruptions
- Systemic glucocorticoid-induced acne
- Perioral eruptions from topical and inhaled glucocorticoids
- Topical and inhaled glucocorticoid-induced perioral eruptions
- Hypopigmented and rosacea-like perioral eruptions from topical glucocorticoids
- Topical steroid withdrawal ('steroid addiction')
- Wound healing and other skin effects
Drug Interactions and Dose Alterations
What raises or lowers the dose a patient actually needs
- Drugs and conditions that require a higher dose
- Drugs and conditions that require a lower dose
- Interactions that worsen a specific side effect
- Effects on other drugs' dose requirements
- Glucocorticoid (GC) therapy: dosing and side-effect considerations related to drug interactions and medical conditions.
- Glucocorticoid (GC) therapy: dosing and side-effect considerations related to drug interactions and medical conditions. (continued)
- Key takeaways
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Dermatology, 5th Edition (2-Volume Set)