Anti-inflammatory Corticosteroids

Question 1

Dexamethasone (Decadron) dose, onset, duration?

Answer 1

dose: 4 mg
onset: ~1 hour
duration: > 24 hours

(no peak)

Question 2

Dexamethasone (Decadron) mechanism of action?

Answer 2

• provides organ protection via anti-inflammatory and immunosuppressive effects by decreasing capillary permeability, neutrophil migration, inflammatory cytokine, and chemokine production
• binds to cytoplasmic receptors to stimulate transcription and the synthesis of proteins; glucocorticoid effects only

Question 3

How is dexamethasone (Decadron) metabolized?

Answer 3

hepatic metabolism

renal elimination

Question 4

Effects of dexamethasone (Decadron) on the body? (pulmonary and other)

Answer 4

pulmonary - useful for preop prep (1-2hr prior) of asthma patient, as well as intraop treatment of bronchospasm

other:
- possible benefit to post gastric aspiration

• decreases cerebral edema and ICP secondary to ischemic injury (less of an affect on closed head injuries)
• very effective PONV treatment
• decreases inflammation and immune response
• if patient on chronic corticosteroid treatment, HPA axis may be suppressed and corticosteroid supplement may be required for major stress symptoms (25mg cortisol)

Question 5

Hydrocortisone (Solu-Cortef) dose and duration?

Answer 5

dose: 25 - 150 mg Q12h
duration: 8 - 12 hours

(no onset or peak)

Question 6

Hydrocortisone (Solu-Cortef) mechanism of action?

Answer 6

• provides organ protection via anti-inflammatory and immunosuppressive effects by decreasing capillary permeability and neutrophil migration
• binds to cytoplasmic receptors to stimulate transcription and the synthesis of proteins
• anti-inflammatory (glucocorticoid) effect
• renal sodium retention (mineralocorticoid) effect

Question 7

How is hydrocortisone (Solu-Cortef) metabolized?

Answer 7

hepatic metabolism

renal elimination

Question 8

Effects of hydrocortisone (Solu-Cortef) on the body?

Answer 8

• decreases inflammation and immune response
• renal sodium retention
• if patient on chronic corticosteroid treatment, HPA axis may be suppressed and corticosteroid supplement may be required for major stress symptoms (minor - 25mg x1; major - 150mg x1-2 days)

Question 9

Which is more potent: hydrocortisone or dexamethasone?

Answer 9

dexamethasone is 25 times more potent than hydrocortisone