Question
Corticosteroids.
Q5 8 marks Short Essays ★ ✓
Answer
Classification (by glucocorticoid:mineralocorticoid potency ratio)
Group Examples Short-acting, high mineralocorticoid activity Hydrocortisone, Cortisone Intermediate-acting, minimal mineralocorticoid activity Prednisolone, Methylprednisolone Long-acting, negligible mineralocorticoid activity Dexamethasone, Betamethasone Pure mineralocorticoid Fludrocortisone
Mechanism of action
Corticosteroids diffuse across the cell membrane and bind cytoplasmic glucocorticoid receptors; the activated complex translocates to the nucleus and alters gene transcription — a genomic mechanism explaining the characteristically delayed onset of anti-inflammatory action. Key downstream effects: induction of lipocortin-1, which inhibits phospholipase A2 and cuts off the entire eicosanoid cascade (prostaglandins and leukotrienes) at its source; suppression of pro-inflammatory cytokine gene transcription (IL-1, IL-2, IL-6, TNF-alpha); reduced leukocyte migration/adhesion; and lymphocyte redistribution/suppression underlying the immunosuppressive effect.
Therapeutic uses
Replacement therapy — Addison’s disease
Anti-inflammatory/immunosuppressive use — rheumatoid arthritis, SLE
Allergic emergencies — anaphylaxis, angioedema, severe asthma
Organ transplant rejection prophylaxis
Cerebral edema (dexamethasone, minimal mineralocorticoid effect avoids counterproductive fluid retention)
Nephrotic syndrome
Antenatal fetal lung maturation in threatened preterm labour
Adverse effects
Cushingoid features, hyperglycemia (insulin-antagonist metabolic effect), osteoporosis
Peptic ulceration, increased susceptibility to infection
Hypertension, growth retardation in children, cataract/glaucoma
Adrenal suppression — risk of adrenal crisis on abrupt withdrawal, requiring tapering after prolonged use
Psychiatric disturbances, myopathy
1 Corticosteroids
Other Years Asked
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