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Chapter 1: About Drugs in General    
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Steroids1

Introduction

Steroids (also known as corticosteroids) are an important and potent group of drugs. They are found in the body naturally as hormones, being secreted by the adrenal glands. They have many different actions in the body, involving the immune response, water and mineral metabolism, anti-inflammatory action, etc.

Types of Steroids

i)

Natural: found in the body as hormones, e.g., hydrocortisone, corticosterone, aldosterone.

 
ii) Synthetic: manmade (artificially made in laboratories) steroids, used as drugs, e.g., prednisolone, betamethasone and dexamethasone.  
   

They may be given orally or by injections, or used locally in the form of ointments or creams.

Preparations of Steroids

Oral Short acting - Cortisone
 

  Hydrocortisone
  Intermediate - Prednisone
      Prednisolone
  Long acting - Dexamethasone
    Betamethasone
Topical (for application to skin)    
  Low potency   Hydrocortisone
  Medium potency   Betamethasone Fluocinolone
     

Beclomethazone

Triamcinolone
  High potency   Clobetasol

Functions/Actions of Steroids

*

Metabolic actions - they influence the metabolism of carbohydrates, fats, proteins, minerals and water. They raise the level of glucose in the blood, and increase the breakdown of tissues (resulting in wasting). The fat in the body is re-distributed in the neck, shoulders and face. Salt (VVsodium chloride) is retained in the body. Calcium absorption is reduced, and this influences bone structures.

       
* Anti-inflammatory action - they prevent or suppress the features of inflammation such as pain, swelling, local warmth and redness. Thus there is marked relief of these symptoms in inflammatory conditions such as rheumatoid arthritis. However the cause of inflammatory reaction is not controlled. This effect can be seen also when steroids are applied locally in the form of a cream or ointment to certain inflammatory skin conditions, e.g., eczema.
* Anti-allergic action - steroids suppress the body's allergic response (response to foreign substances) directly, as well as by their anti-inflammatory action.
* Anti-immunologic action - steroids suppress the body's natural immune mechanism against infection, and so increase the susceptibility of the body to various types of infection (bacterial, viral, fungal and parasitic).
* Suppression of natural hormones: Steroids given by mouth in high doses for prolonged periods cause a decrease in the secretion of the natural steroids in the body. Hence if they are stopped abruptly this may lead to problems.
Side Effects of Steroids
* Ulceration of the stomach - may occur even with a few days of .  
* Swelling of neck, face and obesity due to fat deposition.  
* Ulceration of stomach-may occur even with a few days of treatment.  
* Weakening of the bones leading to fractures (a condition called osteoporosis)  
* Glaucoma and cataract formation may occur in some patients using steroid drops in the eye.  
* Raised blood pressure (hypertension), swelling of the body (edema).  
* Symptoms and signs of diabetes.  
*

Swelling of neck, face and obesity due to fat deposition.

 
* Decrease (retardation) of growth in children.  
* Masking (suppression) of signs and symptoms of serious infection.  
* Changes in body hair - increase in body hair, loss of scalp hair may be seen.  
*

Delayed wound healing,

 
* Aggravation (increase in severity) of skin infections when applied locally.  
* Skin changes may be seen on local application, especially when potent steroids are used - thinning of skin, lightening of skin colour, easy bruising.  
 

Uses of Steroids

a) In Addison's disease, a condition where insufficient or no natural hormones are produced in the body.  
 
b)

In certain life threatening emergencies, when it is necessary to suppress the inflammatory response of the body temporarily, e.g., acute allergic reactions, acute asthma not responding to ordinary drugs.

 
 
c) In certain other acute and chronic inflammatory conditions, e.g., acute rheumatic fever, leukemia and some other cancers, pemphigus and some other skin diseases, and rheumatoid arthritis.  
 
  Ulceration of the stomach - may occur even with a few days of taking steroids.  
  Swelling of neck, face and obesity due to fat deposition.  
d) In certain inflammatory/allergic skin, eye and ear conditions, e.g., eczema, psoriasis, and some types of inflammations of the eye.  
   

     
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