Post on 15-Jan-2017
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STEROIDS &
ANABOLIC STEROIDSBy: Mrs. Kalaivani Sathish,
Asst Professor,PIMS - Panipat
INTRODUCTION
• Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex.
• Corticosteroids includes natural glucocorticoids and mineralocorticoids, and their synthetic analogues.
Functions of Steroids
• Stress response• Immune response• Regulation of inflammation• Carbohydrate metabolism• Protein catabolism• Blood electrolyte level maintenance• Control of behavior
Biosynthesis• Synthesis of steroids are from adrenal cortical
cells from cholesterol.• Adrenal cortex is divided into three zones
– Zona glomerulosa – mineralocorticoids such as aldosterone, which regulates sodium and water are produced.
– Zona fasiculata – glucocorticoids such as hydrocortisone and corticosterone, which regulates carbohydrate and protein metabolism and Na+ & H20 balance are produced.
Biosynthesis (Cont..)– Zona reticularis– involved in the biosynthesis of
androgens.
STEROIDS CLASSIFICATIONSMineralocorticoids (Cortisone,
Fludrocortisone)Glucocorticoids (Betamethasone,
Methylprednisolone)Sex Steroids (Estrogen, Progestins)
MECHANISM OF ACTION• Steroids in blood binds to transcortin
• Glucocorticods molecules binds to cytoplasmic receptor protein
• Structural changes occurs in receptor steroid Complex
• Migration of steroid complex into nucleus
MECHANISM OF ACTION
• Binding of glucocorticoid response elements on the chromatin.
• Suppression of genes
• Genes inhibition contributes to their anti-inflammatory & Immunosuppressive
action.
PHARMACOLOGIC ACTION• Carbohydrate and Protein Metabolism• Fat Metabolism – promotes lipolysis• Calcium metabolism & water excretion• Cardiovascular – permissive effects• Skeletal muscles – weakness in case of hypo
and hypercorticism• CNS – Precipitates seizure in epileptic patients.• Stomach – increased secretion of gastric acid
and pepsin.
PHARMACOLOGIC ACTION• Hemopoitic System - se in number of
RBC’s & Platelets, but decrease in lymphocytes, eosinophills and basophils.
• Inflammatory Response– reduction of phagocytic activity.
• Immunologic and allergic response – Suppresses all types of allergic phenomenon and hypersensitization.
Pharmacokinetics• Absorption – effective in oral route, acts rapidly by
IV / IM.• Bioavailability – oral bioavailability of synthetic
corticosteroids are high.• Plasma protein binding is 90 %.• Metabolism by hepatic microsomal enzymes.• Excretion – urine• Distribution – widely distributed – 10L/Kg• Plasma t ½ - 66 minutes.
Preparations & Doses
• Synthetic steroids have largely replaced the natural compounds in therapeutic use because they are potent, longer acting and more selective for glucocorticoid / mineralocorticoid actions.
Preparations & Doses(Glucocorticoids)
Category Compound
Short Acting (t1/2 <12h) Hydrocortisone (cortisol)
Intermediate acting (t1/2 12 – 36 h) PrednisoloneMethylprednisolone
Long acting (t1/2 > 36 h) DexamethasoneBetamethasone
Doses & Routes(Glucocorticoids)
Category Compound
Short Acting (t1/2 <12h) Hydrocortisone (cortisol) 20 mg, 100 mgOral, IV
Intermediate acting (t1/2 12 – 36 h) Prednisolone 5 – 60 mg / day oral, IMMethylprednisolone 4 – 32 mg, Oral, IV
Long acting (t1/2 > 36 h) Dexamethasone 0.5 – 5 mg / day oral, IV, IMBetamethasone 0.5 – 5 mg / day oral, IV, IM
Doses & Routes(Mineralocorticoids)
Category Compound
Mineralocorticoids Desoxycortisone 2 – 5 mg once or twice weekly, sublingual, IM
Aldosterone
(Aldosterone is not used clinically)
Indications
– Replacement Therapy: Acute adrenal insufficiency,
Chronic adrenal insufficiency and congenital adrenal
hyperplasia.
– Pharmacotherapy: Collagen disease, Arthritis, Severe
allergic reactions, Autoimmune disease, Bronchial asthma,
Infective diseases, Eye diseases, Skin diseases, intestinal
diseases, cerebral edema, Malignancies, Organ
transplantation and skin alograft, septic shock, thyroid
storm.
CONTRA INDICATIONS
ABSOLUTE• Hypersensitivity• Cushing syndrome• Herpes Ocular Infections
RELATIVE• Peptic ulcer• DM and HTN• Viral and fungal infections• TB• Osteoporosis• Psychosis• Epilepsy• CHF• Renal failure
ADVERSE EFFECTS• Occurs usually with prolonged therapy
• Mineralocorticoids • Na and water retention, edema,
hypokalemic alkalosis and HTN.• Glucocorticoids
• Cushing habitus – Characterized by moon like face, accumulation of fat in the truncal region.
ADVERSE EFFECTS• Glucocorticoids
• Hyperglycemia and Glycosuria• Myopathy & Muscle• Susceptibility to infections• Peptic ulceration• Osteoporosis• Glaucoma • Growth retardation in children• Fetal abnormality (IUGR)
NURSES ROLE• Check vital signs, lung sounds, BP and
weight.• Conduct MSE, to assess for depression,
withdrawal, Insomnia and anorexia.• Advise regular opthalmic examination• Check stool for occult blood periodically.• Administer suitable antibiotics as prescribed. •
ANABOLIC STEROIDS
DEFINITION• These are androgens with anabolic
properties and are rarely prescribed., but are commonly abused by athletes in an
attempt to enhance performance.• They are developed in replace of androgens.
MECHANISM OF ACTION• Testosterone is converted to active metabolite
dihydrotestosterone
• Increased synthesis of RNA & Cellular protein
• Stimulate growth of muscle, bone, skin and hair and accelerate closure of epiphyses at ends
of long bones. (ed the RBC production)
• Indications – Growth and development retardation.– Ulcerative colitis– Osteoporosis– Aplastic anemia– After trauma & surgery– Prolonged immobilization
• Contra Indications• Pregnancy, Lactation, CHF, Renal failure,
Liver failure and prostate enlargement.
• Adverse Effects• Hepatotoxicity
• Hepatitis B & C• Abusers of anabolic steroids use same needles so risk of
HIV / AIDS.• Nurses Role
• Do not administer for more than 90 days.• Assess the client for Liver function edema, weight gain
and skin changes• Evaluate the client for signs of depression.
• Warm and shake vials before administer to prevent crystals. Administer in deep into gluteal muscles