Steroids

• Glucocorticoid Cessation
  • Indications
    • Therapeutic benefit achieved
    • Uncontrolled SE (hypertension)
    • Severe complications (psychosis)
  • Risks
    • Adrenal insufficiency from HPA axis suppression
  • When to taper
    • ≥3 weeks of daily use
    • Cushingoid appearance
• Glucocorticoids
  • Natural
    • Cortisone Acetate
    • Hydrocortisone
      • 20mg eq, 1 anti inflame potency, 8-12hr, 1/125 mineralocorticoid
    • Pregnenolone
  • Synthetic
    • Cortisol like
      • Fludrocortisone (Florinef)
        • 1 mineralocorticoid potency
      • Methylprednisolone
        • 4mg eq, 5 anti inflame, 18-36hrs, no mineralocorticoid
      • Prednisolone
        • 5mg eq, 4 anti inflame, 18-36hrs, 1/150 mineralocorticoid
      • Prednisone
        • 5mg eq, 4 anti inflame, 18-36hrs, 1/150 mineralocorticoid
    • Methasones
      • Alclometasone
      • Beclometasone (Qvar)
      • Betamethasone
      • Clobetasol
      • Clobetasone
      • Dexamethasone
        • 0.75mg eq, 25-50 anti inflame, 36-54hrs, no mineralocorticoid
      • Fluticasone
      • Mometasone
      • Triamcinolone
    • Cyclic Ketals
      • Budesonide (Pulmicort)
• Anti-glucocorticoids
  • Antagonists
    • Aglepristone
    • Ketoconazole
    • Mifepristone
    • Ulipristal Acetate
• Synthesis modifiers
  • Ketoconazole
• Muscle Relaxants
  • Succinylcholine
    • CI: Burns, Neuromuscular Disease/Paraplegia, Eye Trauma, Raised ICP
  • Anesthetic Induction Agents
    • Propofol, Midazolam, Sodium Thiopental

  • Steroids

    • Cushings, Sodium retention/K+ wasting (hypertension), osteopenia, ischemic bone necrosis, myopathy
  • Cancer Drugs
    • Calcineurin Inhibitors
      • block T cell activation by preventing IL-2 Transcription
      • Cyclosporine and Tacrolimus
        • Highly Nephrotoxic
      • Sirolimus (Rapamycin)
        • Not nephrotoxic