Glucocorticoids

• Pharmacology

  • oral or IV

  • binds extensively to serum albumin, so increased bioavailability with low serum albumin

• Mechanisms of action

  • binds glucocorticoid receptor and regulates transcription of a multitude of genes for the initiation, implementation of immune responses

  • glucocorticoids enhance IκB expression (i.e., decrease NF-κB); impairs expression of a number of cytokines (decreases IL-1, 2, 3, 6, TNFα, IFN-γ)

  • lympholytic; causes redistribution of lymphocytes into nodes; decreases activation of cytotoxic T lymphocytes (CTLs)

• Common side effects, which generally are associated with high doses of systemic glucocorticoids and not inhaled agents
  

  • hypertension

  • glucose intolerance

  • dyslipidemia

  • osteoporosis; avascular necrosis of femoral head

  • decreased wound healing

  • cataracts

  • enhanced risk of infection; decreased signs of infection. “patients smile all the way to the morgue”

• we use it early, at the time of transplantation; it is a mainstay of treatment for autoimmune diseases and a variety of inflammatory diseases

Category: Medical Subject Notes , Pathology Notes