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Corticosteroids, Steroids
Naturally-occurring hormones produced by the adrenal glands
Glucocorticoids: Hydrocortisone
Mineralcorticoids: Aldosterone
Sex Hormones: Testosterone
Actions of Glucocorticoids
Anti-inflammatory
Supresses actions of kinins, cytokines, and other mediators of inflammation
Maintains microcirculation and minimizes edema
Maintains cell membrane integrity
Inhibits macrophage movement
Bronchodilation
Potentiates catecholamine activity by inhibiting COMT and increasing adenyl
cyclase production
Decreased cholinergic and alpha stimulation
Decreased phosphodiesterase production
Steroid Uses
Acute Inflammation
Organ Transplant
Allergic Inflammation
Sodium retention
Fluid retention
Potassium loss and metabolic
alkalosis
Dependency
Both physical and psychological
Patients may need to be
weaned from steroid therapy
Hydrocortisone
Brand name(s): Solu-Cortef, Cortef
Given orally or IV
Not usually aerosolized because of side effects
Prednisone (Prednisolone)
Brand: Deltasone, Delta-Cortef
4X as potent as hydrocortisone
Given orally
Side effects minimized if given every other day
Patients usually need to be weaned from it
Methylprednisolone
Brand: Solu-Medrol
Oral or IV
Often used to help relieve airway inflammation
Triamcinolone
Brands: Azmacort, Kenalog
MDI- to prevent airway inflammation
Dexamethasone
Brand: Decadron
Often nebulized for acute upper airway
inflammation
What else is used with it?
Beclomethasone
Brands: Vanceril, Beclovent, Becotide
MDI to prevent airway inflammation
Mometasone Furoate
Brand: Asmanex
DPI Twisthaler 220mcg per pff
Started as one puff per day in then evening and
may go as high two puffs BID
Flunisolide
Brand: AeroBid
MDI to prevent airway inflammation
Usually effective when given only BID
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)
Budesonide
Brand: Pulmicort
MDI to prevent airway inflammation
Seems to get best effects with minimal side
effects
NSAIDs
Drugs that prevent airway inflammation
but usually have less side effects than
steroids
Cromolyn Sodium
Brands: Intal, Aarane
Is a mast cell stabilizer so used to prevent airway
inflammation
Does not relieve airway inflammation!
Nedocromil Sodium
Brand: Tilade
Similar to cromolyn sodium (used to prevent
airway inflammation)
MDI usually only needed B.I.D.
Zileuton (Zyflo)
Taken as a pill Q.I.D.
Montelukast (Singulair)
Taken as a pill just once a day