Presentation on theme: "April Merrill, MS, APRN, CCNS. Identify the different categories of steroid medications Identify the uses for steroid medications Identify side-effects."— Presentation transcript:
April Merrill, MS, APRN, CCNS
Identify the different categories of steroid medications Identify the uses for steroid medications Identify side-effects and precautions for steroid medications
Hormones- secreted by cells to regulate the activity of other cells. Growth Development Behavior Reproduction Coordinates the production, use and storage of energy. Homeostasis Nutrition Metabolism Excretion Water and salt balance
The term steroid refers to any synthetic (man made) or naturally occurring fat (lipid) soluble compound that has a physiological response. Steroids are hormones derived from cholesterol and differ only in the ring structure and side chains attached to it.
Adrenalcortical steroids Progesterone & related steroids Androgens Estrogens Bile acids & bile salts Cholesterol
Progestogens (also known a progestins) such as progesterone Produced from the corpus luteum in normal menstrual cycle Estrogens, including estradiol and estrone produced primarily by developing follicles in the ovaries, the corpus luteum, and the placenta promote the development of female secondary sexual characteristics, such as breasts involved in the thickening of the endometrium and other aspects of regulating the menstrual cycle.
Testosterone primarily secreted in the testes of males and the ovaries of females plays a key role in the development of male reproductive tissues such as the testis and prostate promotes secondary sexual characteristics such as increased muscle, bone mass and the growth of body Prevents osteoporosis
Structural Definition Not found in nature. How they are prepared. Semi-synthetic Natural Source Materials Synthetic Chemistry Derivation Advantages Cost Highly variable structure
Anabolic steroids are synthetic versions of testosterone, the body’s natural sex hormone. They assist athletes by facilitating efforts to gain strength and muscle mass for increased muscular endurance, power and speed. Stimulation of: Sexual development Growth Puberty Bone marrow Appetite Muscle Mass Stamina
Hormonal System Men Infertility Breast development Shrinking of the testicles Women Enlargement of the clitoris Excessive growth of body hair Both Sexes Male-pattern baldness Muscoloskeletal System Short stature Tendon rupture Cardiovascular System Heart attacks Enlargement of the left ventricle Liver Cancer Peliosis hepatis Skin Acne and cysts Oily scalp
Altered hormone levels Inability to control behavior Severe mood swings Irritability Violent aggression Depression
Dosage mg caps daily Street price- $1 for 40 mg Half-life: 3-5 hrs
Dose mg daily $2-3 per 200 mg cap Lack of popularity Slightly androgenic Expensive
Dosage: mg/ day Price: 2 50 mg tablets for $1 First oral steroid Works well; bad side effects and high cost Potent androgen Prone to ‘roid rage’
Dosage: mg/ week Price: $10-30/ ml Stacks well with any compound Extreme anabolic tendencies Good and bad Injectables
Glucocorticoids- cortisol controls carbohydrate, fat and protein metabolism anti-inflammatory by preventing phospholipid release, decreasing eosinophil action Mineralocorticoids-aldosterone controls electrolyte and water levels, mainly by promoting sodium retention in the kidney.
Digoxin, thiazide / loop diuretics due to hypokalemia NSAIDs due to GI bleeding Insulin and oral hypoglycemics due to hyperglycemia Vaccines due to immunosuppression No live vaccines
Need for additional doses during stress if replacement Tapering if not replacement DO NOT ABRUPTLY STOP (with exceptions) Alternate day dosing Theoretically there is less endogenous corticosteroid suppression (via feedback)
Potency can vary greatly between various drugs, preparations (cream vs. ointment), and routes of administration Systemic absorption also varies based on route Ex. Topical cream/ointment will have greater systemic effect if skin broken vs. intact
Class/PotencyBrand NameGeneric CLASS 1—Superpotent Clobex Lotion/Spray/Shampoo, 0.05% Clobetasol propionate Diprolene Ointment, 0.05% Betamethasone dipropionate CLASS 2—Potent Lidex Cream/Gel/Ointment, 0.05% Fluocinonide CLASS 3—Upper Mid- Strength Lidex-E Cream, 0.05%Fluocinonide CLASS 4—Mid-Strength Kenalog Cream/Spray, 0.1% Triamcinolone acetonide CLASS 5—Lower Mid- Strength Capex Shampoo, 0.01%Fluocinolone acetonide CLASS 6—Mild Aclovate Cream/Ointment, 0.05% Alclometasone dipropionate CLASS 7—Least Potent Cortaid Cream/Spray/Ointment Hydrocortisone
Give with food Give before 9 am to mimic circadian rhythm Contraindicated if systemic fungal infection Caution with pregnancy or lactation, HTN, heart disease, renal failure, GI irritation, DM