Corticosteroids
PREGNANCY CATEGORY C
Therapeutic Actions
Corticosteroids enter target cells and bind to cytoplasmic receptors, initiating many complex reactions that are responsible for anti-inflammatory, immunosuppressive (glucocorticoid), and salt-retaining (mineralocorticoid) actions. Some of these actions are considered undesirable, depending on the indication for which the drug is being used.
Indications
Systemic Administration
Replacement therapy in adrenal cortical insufficiency
Treatment of hypercalcemia associated with cancer
Short-term management of inflammatory and allergic disorders such as rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases (eg, pemphigus), status asthmaticus, and autoimmune disorders
Management of hematologic disorders—thrombocytopenic purpura, erythroblastopenia
Treatment of trichinosis with neurologic or myocardial involvement
Treatment of ulcerative colitis, acute exacerbations of MS, and palliation in some leukemias and lymphomas
Inhalation
Treatment of asthma, COPD
Intra-articular or soft-tissue administration
Treatment of arthritis, psoriatic plaques
Retention enema
For ulcerative colitis, proctitis
Dermatologic preparations
Relief of inflammatory and pruritic manifestations of dermatoses that are steroid-responsive
Anorectal cream, suppositories
Relief of discomfort from hemorrhoids and perianal itching or irritation
Contraindications and Cautions
Systemic administration
Infections, especially tuberculosis, fungal infections, amebiasis, hepatitis B, vaccinia, or varicella, and antibiotic-resistant infections; kidney disease (predisposes to edema); liver disease, cirrhosis, hypothyroidism; ulcerative colitis with impending perforation; diverticulitis; recent GI surgery; active or latent peptic ulcer; inflammatory bowel disease (drug may cause exacerbations or bowel perforation); hypertension, heart failure; thromboembolitic tendencies, thrombophlebitis, osteoporosis, convulsive disorders, metastatic carcinoma, diabetes mellitus; lactation.
Retention enema, intrarectal foam
Systemic fungal infections; recent intestinal surgery; extensive fistulas.
Topical dermatologic administration
Fungal, tubercular, herpes simplex skin infections; vaccinia, varicella; ear application when eardrum is perforated; lactation.
Adverse Effects
Systemic administration
CNS: Vertigo, headache, paresthesias, insomnia, seizures, psychosis
CV: Hypotension, shock, hypertension and CHF secondary to fluid retention, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias secondary to electrolyte disturbances
Dermatologic: Thin, fragile skin; petechiae, ecchymoses, purpura, striae, subcutaneous fat atrophy
Endocrine: Amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance and diabetes mellitus, cushingoid state (long-term therapy), hypothalamic-pituitary-adrenal (HPA) suppression systemic with therapy longer than 5 days
Eye: Cataracts, glaucoma (long-term therapy), increased IOP
GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased appetite and weight gain (long-term therapy)
Hematologic: Sodium and fluid retention, hypokalemia, hypocalcemia, increased blood sugar, increased serum cholesterol, decreased serum T3 and T4 levels
Hypersensitivity: Anaphylactoid or hypersensitivity reactions
Musculoskeletal: Muscle weakness, steroid myopathy and loss of muscle mass, osteoporosis, spontaneous fractures (long-term therapy)
Other: Immunosuppression, aggravation or masking of infections, impaired wound healing
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