So, with corticosteroids, we have 2 types:
we have mineralocorticoids,
and we have glucocorticoids.
So, that's why you see the
2 columns on your screen.
Mineralocorticoids are like aldosterone,
and glucocorticoids are like cortisol.
So, let's look at what each one
of these special group does.
electrolyte and water levels.
Think specifically, sodium.
So, write Na or spell out the word "sodium"
above that just to help you remember.
Now, how it promotes sodium
retention in the kidneys,
which means when aldosterone
is present, then that --
the kidneys know to reabsorb more sodium.
And wherever sodium goes, water follows.
So, now I have more volume on board.
Remember, when I have more volume
in my intravascular space,
my blood pressure is likely to be elevated.
Now, the second type of corticosteroids --
mineralocorticoids was aldosterone,
glucocorticoids is cortisol.
And usually, the effect we're after is number 2.
So, put a star after that.
Most often, when we give corticosteroids, what
we want to do is go after the cortisol effect.
Now, we end up with some carb,
fat, and protein metabolism,
but there's what we're looking
for, that second point.
We want the anti-inflammatory response.
We want less eosinophil action.
We give glucocorticoids to suppress
inflammation in lots of diseases and states.
So, make sure you make a special note
that although we get all these other
effects sometimes along with it,
they're not the therapeutic intended effect.
Now, if the patient's adrenal
gland is done, it's shot,
then, yeah, we're going to have
to replace all these things.
But for the majority of our patients, we're going
to be looking for that anti-inflammatory effect.
That is the therapeutic goal
for using corticosteroids.
Now, I put this chart up here, but
I don't want it to overwhelm you.
I just want you to kind of see.
Look at the very top.
You have hydrocortisone or cortisol.
Its glucocorticoid potency is 1.
Its mineralocorticoid potency is 1, okay?
So, the duration of hours is just kind
of good-to-know information there.
But what I want you to focus in
on are those first 2 columns.
Now you can see with that
medication, we've got a 1:1 ratio.
We've got just as much glucocorticoid
potency as we do mineralocorticoid.
Every drug listed under hydrocortisone
is a comparison of that.
So prednisone has 3.5-5 a times of
effect of glucocorticoid potency,
and 0.8 of mineralocorticoid.
Hey, now, why would we do that?
Well, we talked about what we're looking
for is the anti-inflammatory effect.
We don't necessarily want the
mineralocorticoid sodium water effect.
That's why, in making these new medications,
you can see as we progress,
look all the way at the bottom.
Dexamethasone is 25-80 for glucocorticoid
potency, where we've got 0 for mineralocorticoid.
So, it depends on what effect we're
trying to get from the patient.
Dexamethasone is a pretty strong one
as far as glucocorticoid potency,
and they've eliminated the mineralocorticoid.
Do not spend time memorizing this chart.
This is just here for you to have kind of the
idea that we use cortisone as a standard,
and that the other glucocorticoids that we have
tend to have higher glucocorticoid potency,
and lower mineralocorticoid potency.
So, what specifically do we use
to treat corticosteroids for?
Well, hang on because there
is a very long list here.
We can use it for joint pain and
inflammation, arthritis, dermatitis,
allergic reactions, asthma, hepatitis,
lupus, inflammatory bowel disease,
replacement for Addison's disease.
And sometimes, I think we just give it when we don't
know what else to do, we try corticosteroids, okay?
So, we use it --
This is a partial list.
This isn't even a complete list of all the
opportunities we use with corticosteroids.
But the undesired effect is that we end up
with a drug induced Cushing's syndrome.
It's not what we want.
We'd love to be able to just be more selective
about getting that anti-inflammatory response.
But remember back to that chart, we've
tried to tweak that with medications,
but you're still going to have
some other undesired effects.