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Rational use of Steroids

Rational use of Steroids. Sachin Kuchya, MD DNB. Steroids - Introduction. Three classes,

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Rational use of Steroids

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  1. Rational use of Steroids Sachin Kuchya, MD DNB

  2. Steroids - Introduction Three classes, • Glucocorticoids – The daily secretion of cortisol is about 20 mg/ day with diurnal variation, peaks during early morning hrs, lowest during late evening hrs. Also exert feedback inhibition on HPA axis, maximal inhibition during late evening hours • Mineralocorticoids – for salt & water balance • Sex steroids – for reproductive function

  3. IRRATIONAL USE ? • Glucocorticoids – most common.

  4. Example 1 • Methylprednisolone 4 mg / Prednisolone 4 mg / Dexamethasone 0.5 –1.0 – 2 mg three times daily for treating an episode of Asthma exacerbation / attack of Gouty arthritis. Why Irrational – Inadequate Immunosupression & risk of HPA axis suppression

  5. Example 2 • IV Hydrocortisone 100 – 200 mg every 6 hourly / IV Methyl prednisolone 40 – 125 mg every 8 hourly for status asthmaticus (even included in some guidelines) Why Irrational –Risk of salt & water retention ( greater with hydrocortisone) & risk of HPA axis suppression

  6. Steroids – Classification(on the basis of biological half lives)

  7. Steroids – Classification

  8. Glucocorticoids - Indications • As hormone replacement therapy – in deficiency syndromes like Addisonian states ( physiological replacement doses) • For HPA axis suppression, in Congenital Adrenal Hyperplasia (physiological doses are sufficient) • Anti Inflammatory activity / Immunosuppressive action (5- 20 times of physiological doses)

  9. Glucocorticoid - Doses

  10. Glucocorticoid – Preferred ones

  11. Glucocorticoids – Dosing regimen

  12. Rational use…. Example 1 Methylprednisolone 4 mg / Prednisolone 4 mg / Dexamethasone 0.5 – 2 mg three times daily for treating an episode of Asthma exacerbation / attack of Gouty arthritis. The rational regimen for treating an episode of Asthma exacerbation / attack of Gouty arthritis - Methylprednisolone 16 - 32 mg / Prednisolone 20 - 60 mg once daily / on alternate days, repeated at 8 AM in the morning.

  13. Rational use….. Example 2 IV Hydrocortisone 100 – 200 mg every 6 hourly / IV Methyl prednisolone 40 – 125 mg every 8 hourly for status asthmaticus (even included in some guidelines) The rational regimen for status asthmaticus–IV Methylprednisolone 125 – 1000mg stat followed by oral regimen stated above (example 1), once the condition settles down.

  14. Benefit of RUD - Glucocorticoids Better immunosupression in patients with Br Asthma / RA / without any HPA axis inhibition Adequate inhibition of HPA axis in patients with Congenital Adrenal Hyperplasia, without salt & water overloading.

  15. Thank you, wish to have your views & comments. Based on Goodman & Lawrence.

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