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Corticosteroid: what it is, how to use it, indications and side effects

Corticosteroid: what it is, how to use it, indications and side effects

Corticosteroids, as we know it, are a class of anti-inflammatory and immunosuppressive drugs - that is, used to suppress the body's defense mechanisms, a necessary procedure for performing transplants and grafts, for example. This medication is made from a hormone produced by our body called cortisol, which is produced in the adrenal glands. Corticosteroids, therefore, are a synthetic derivative of this hormone, with the same nucleus, but its structure is modified to potentiate its action and function in the body.

Corticosteroids, also known as corticosteroids, glucocorticoids and steroidal anti-inflammatory drugs , are very powerful and have the most diverse indications to use. However, because they are a kind of synthetic hormone, they do not only act where the problem is, and may end up altering the functioning of the whole organism. Its use requires care and the medical indication is essential, as well as following the guidelines of posology to the letter and the protocol of withdrawal of the medicine of the organism also.

Classes of the corticoids

The corticoids are divided in two classes, according to with the types of steroid hormones that the adrenal gland produces: glucocorticoids and mineralocorticoids.

Glucocorticoid, often referred to as a corticosteroid, is the most important cortisol in the human body and is also produced naturally and is responsible for regular and support various actions of the body, such as metabolic, cardiovascular, immune and homeostatic functions. It is in this decorticoid class that the drugs used as immunosuppressants and anti-inflammatories are concentrated and thus of great importance for the treatment of autoimmune diseases, such as Lupus.

Mineralocorticoids are part of the second class of steroid hormones, responsible corticoid formation. Its main function is due to the hormone aldosterone. It has a great influence on the electrolyte balance (ions and water) and is also responsible for the sodium balance, as it acts directly on the kidneys, contributing to the proper functioning of these organs.

Types

Steroids are available in different pharmaceutical forms and recommendations for use. It can be found in oral medications (tablets and syrups), in injectable form, as eye drops, for topical use (ointments and creams) and even inhalation - commonly used for the treatment of chronic asthmatic bronchitis. Over the decades, this medicine, which is quite old, has been improved, new molecules have been created, and its side effects more documented, causing companies to include in their formulations other medicines that help combat them or prevent them from becoming Corticosteroids can be divided into 5 types:

Topical corticosteroids: these are creams and lotions used to treat allergic reactions or skin conditions such as urticaria and eczema

  • Oral corticosteroids: tablets used to treat diseases Chronic inflammatory conditions such as bronchitis, hepatitis, Crohn's disease or arthritis, for example
  • Injectable corticosteroids: prescribed and administered by the physician to treat chronic problems such as lupus, keloids or rheumatoid arthritis
  • Nasal corticosteroids: are sprays used to treat asthma, allergic rhinitis and other respiratory allergies
  • Ophthalmic corticosteroids: corticosteroids are eye drops that can be used to treat conjunctivitis or uveitis, for example, reducing irritation and redness.
  • When corticosteroid is indicated

Corticosteroid is indicated for a large part of inflammatory reactions and in some cases immunosuppression. Among the diseases that use corticosteroids in treatment are:

Asthma

  • Multiple sclerosis
  • Allergies, mainly anaphylaxis
  • Autoimmune hepatitis
  • Herpes Zoster
  • Lupus
  • Rheumatoid arthritis
  • Leukemia and lymphoma
  • Idiopathic thrombocytopenic purpura (ITP)
  • Multiple myeloma
  • Cerebral edema
  • Gout
  • Sarcoidosis
  • Allergic rhinitis
  • Vitiligo
  • Psoriasis
  • Wegener's granulomatosis
  • Inflammatory bowel disease
  • Vasculitis
  • Addison's disease (adrenal insufficiency)
  • Skin diseases of inflammatory or autoimmune origin
  • Organ transplantation
  • Urticaria
  • It may also be part of the medications used as immunosuppressants (needed in cases of transplants, for example), as antiemetic (decreases nausea and vomiting); in the protocol of a common cancers in children, acute lymphoid leukemia; and in some cases where there is a risk of the baby being born prematurely.

It is important to note that the corticoid is usually used for short periods of time, and when its use is more recurrent or long, other remedies are necessary to try to contain the its most significant side effects.

Corticosteroid functioning

When a person has an inflammation, several substances are responsible for this process and they reflect on the entire body. Corticosteroids, acting as the potentiated cortisol hormone, prevent the production of several of these substances involved in the inflammation and immune response of the person.

When corticosteroids are contraindicated

Corticosteroids do not have an absolute contraindication, but should be used only under medical supervision. People with diabetes, hypertension, osteoporosis or menopause should be more careful with these medications, since they often change blood glucose, blood pressure and are related to a propensity to increase bone fragility.

Children should also be monitored and medicinal products only used in cases of necessity, since their use for long periods can cause damage in muscular and skeletal development. In elderly patients, it is also necessary to evaluate how the metabolism is before prescribing corticosteroids. In summary, for the corticosteroid to be indicated, especially in these more critical cases, its benefits need to outweigh the possible risks. Chronic side effects of corticosteroids

Side effects of corticosteroids are more common in long-term use and include fatigue, increased sugar levels in the blood loss, decreased body defenses, agitation, insomnia, increased cholesterol and triglycerides, headache or glaucoma, for example.

Corticosteroid x Contraceptive pill

It is important to note that corticosteroids interfere with the contraceptive pill Therefore, if you use this method consult your doctor about how best to maintain contraception and for how long it should be used.

Most common adverse reactions during the use of corticosteroids

There are several adverse reactions of corticosteroids, and their severity and intensity are usually related to large dosages or longer duration of use. Among the most common and appearing as early as the first days of treatment are fluid retention, facial flushing, increased blood pressure, increased glycemic rate, edema (swelling) in the body.

Since corticosteroids work in the same way that cortisol, only potentiated, these hormones will most act not only on the part of the body being treated, but in several other areas as well. When used for slightly longer periods, it begins to degrade some proteins in the body, which leads to loss of muscle mass, redistribution of body fat (concentrates on areas such as the face, abdomen and back), decreased immunity, skin that is usually large and purple. In these conditions it may also favor cataracts, increase bone fragility, and the propensity to develop osteoporosis - even more so in patients with other risk factors such as menopausal women.Even topical corticosteroids can offer risks, especially if there are cuts on the spot that are being applied to ointment or cream. These risks are different from the previous ones and are related to decreased immunity. For example, when a corticoid is passed in a cut, the region is more vulnerable to inflammation linked to fungi and bacteria, so several of these products already contain antibiotics and other substances that minimize this side effect. In addition, inhaled corticosteroids, widely used by children with asthmatic crises that "sneeze" the product into the mouth, for example, end up leading to a greater risk of oral candidiasis (fungus) if used too often. In addition, the adverse reactions to the expected effect are different according to the dosage, time of use, and the use format (tablet, injectable, spray, eyedrops, etc.) used.

Corticosteroid fattening?

Unfortunately the response to this question is yes. But it is not very remarkable if used for a short time and the effects usually disappear once the person finishes the treatment. The corticoid is fattening for a number of reasons, among which: it increases appetite, provides water retention, causes redistribution and fat accumulation in the body.

Corticosteroid withdrawal protocol

In addition to following medical recommendations regarding doses of medications and intervals, it is also essential to strictly follow the corticosteroid withdrawal procedure. This is because, depending on the amount of corticosteroid a person is taking in the body to produce cortisol, then gradual withdrawal is necessary for this production to return to normal - also gradually. If abruptly withdrawn the body enters a serious imbalance, since the hormone participates in the regulation of the metabolism, which can even alter the cardiac function.

Risks of the continuous use of corticoid

The corticoid, precisely because it is a medicine of great effect, causes more serious problems when used chronically. In these cases the corticoid is related to the cellular alteration in several parts of the body. People with rheumatoid arthritis and other incurable rheumatic diseases may end up experiencing a worsening of their situation when they use this medicine, since they become dependent on it and when removed there is an expressive worsening. It is also related to more aggressive cancers, can cause central obesity, suppression of adrenal gland function and, when applied to the skin continuously, can mask problems and make the lesions become chronic and difficult to treat. > From this moment she is much more likely to have the adverse reactions we discussed and even aggravate her problem. If the person is being treated for a particular cancer, for example, and uses the corticosteroid indiscriminately to relieve their pain in addition to what has been recommended by the doctor, it can end up causing this cancer to spread to other parts of the body. Therefore, only use this medication when it is indicated by a specialist and following all the proposed treatment to the letter.

Risks of the corticosteroid used without recommendation

Steroids are potent medications with several recommendations and usually show a rapid improvement for the patient. With this, some people may end up using the doses recommended by the doctor in a given inflammation situation to treat a later problem. This process is extremely dangerous, since the person does not know what is related to these new symptoms, if the dose is lower or higher than the recommended, nor if in this case would really require the use of corticosteroids.

Risks of the indiscriminate use of corticosteroids

Corticosteroids are potent medications, with several recommendations and that usually present a rapid improvement for the patient. With this, some people may end up using the doses recommended by the doctor in a given inflammation situation to treat a later problem. This process is extremely dangerous, since the person does not know what is related to these new symptoms, whether the dose is lower or higher than recommended, nor if in this case would really require the use of corticosteroids. Therefore, use this medication only when directed by a specialist and following all the proposed treatment.

Corticosteroids can cause overdose?

All medicines may cause an overdose. The key to a safe treatment is the understanding that there are safe limits to their use, and that these limits involve doses, schedules, combinations with other substances, patient health status, blood tests, and various other relevant questions. potentially dangerous. Therefore, never self-medicate or combine drugs without specific guidance to do so.


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