Review of Pharmacology - 9E (2015)

Review of Pharmacology
Fig. 7.2: Dexamethasone suppression
test
Endocrinology
Antenatal Use of Steroids
• Accelerate fetal lung maturation
• Decrease incidence of PDA
• Decrease risk of intraventricular
hemorrhage
3. Antenatal Use
Betamethasone can be given to accelerate the fetal lung maturation, if delivery is anticipated
before 32 weeks of gestation. In selected patients, antenatal steroid therapy decreases the
incidence, severity and complications of respiratory distress syndrome, and decreases overall
neonatal mortality and morbidity. In addition, antenatal steroids may decrease the incidence
of PDA and periventricular/intraventricular hemorrhage.
4. Non Adrenal Uses
(a) Anti-inflammatory uses: Corticosteroids can be useful in rheumatoid arthritis,
osteoarthritis (intra-articular) and acute gouty arthritis when NSAIDs fail to provide
pain relief. These are also useful in inflammatory conditions of eye like conjunctivitis,
iritis, iridocyclitis and keratitis. However, steroids are contraindicated in herpes
simplex keratitis.
(b) Anti-allergic uses: Corticosteroids are useful in the management of anaphylaxis (DOC
is adrenaline), urticaria, angioedema and serum sickness. These are used by inhalational
route in chronic severe asthma and i.v. (hydrocortisone) route is employed in
acute severe asthma (status asthmaticus). Skin conditions like pemphigus vulgaris,
exfoliative dermatitis and Steven Johnson syndrome also require systemic steroid
therapy.
(c) Immunosuppressive uses: High dose corticosteroid therapy is required in the organ
transplantation to prevent graft rejection. They are also useful in autoimmune
diseases (e.g. myasthenia gravis, hemolytic anemia) and collagen vascular diseases
(like SLE, polyarteritis nodosa and nephrotic syndrome). Steroids are also useful
in patients with ulcerative colitis and Crohn’s disease who are not responding to
5-aminosalicylic acid.
(d) Anti-cancer uses: Due to prominent lympholytic action in malignant cells, steroids
are essential component of the combination therapy of ALL and lymphomas (both
Hodgkin as well as non-Hodgkin). These are also useful in the breast carcinoma.
These can also be used with anti-neoplastic agents to decrease nausea and vomiting.
(e) Other uses
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