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endocrine:drug_classes:corticosteroids [2026/02/12 19:58] – andrew2393cnsendocrine:drug_classes:corticosteroids [2026/02/12 20:18] (current) – [Topical Dermatologic Glucocorticoids] andrew2393cns
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-====== Corticosteroids (Glucocorticoids) ======+====== Corticosteroids (Glucocorticoids & Mineralocorticoids) ======
  
-Corticosteroids are synthetic analogs of adrenal cortex hormones used for anti-inflammatory and immunosuppressive effects.+Corticosteroids are synthetic analogs of adrenal cortex hormones.
  
-This is the **master class** page (hub).   +They are divided into: 
-Each drug below links to its own monograph page.+  * Glucocorticoids (anti-inflammatory / immunosuppressive) 
 +  * Mineralocorticoids (volume regulation)
  
 Core physiology: Core physiology:
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   * [[endocrine:physiology:glucocorticoid_signaling|Glucocorticoid Signaling Pathway]]   * [[endocrine:physiology:glucocorticoid_signaling|Glucocorticoid Signaling Pathway]]
  
----- +★ = High-yield / core drug for mastery
- +
-===== Quick Navigation ===== +
-  * [[#systemic_glucocorticoids|Systemic Glucocorticoids]] +
-  * [[#inhaled_corticosteroids|Inhaled Corticosteroids]] +
-  * [[#intranasal_corticosteroids|Intranasal Corticosteroids]] +
-  * [[#topical_dermatologic_corticosteroids|Topical Dermatologic Corticosteroids]] +
-  * [[#ophthalmic_corticosteroids|Ophthalmic Corticosteroids]] +
-  * [[#gi_rectal_corticosteroids|GI / Rectal Corticosteroids]] +
-  * [[#mineralocorticoids|Mineralocorticoids]]+
  
 ---- ----
  
-===== Core Mechanism (Class-Wide) =====+===== Systemic Glucocorticoids =====
  
-All glucocorticoids: +^ Drug ^ Relative GC Potency ^ Mineralocorticoid Activity ^ Duration ^ ★ ^ 
-  * Bind intracellular glucocorticoid receptor +| [[endocrine:drugs:hydrocortisone|Hydrocortisone]] | Low | Moderate | Short | ★ | 
-  * Translocate to nucleus +| [[endocrine:drugs:cortisone|Cortisone]] | Low | Moderate | Short |  | 
-  * Alter transcription +| [[endocrine:drugs:prednisone|Prednisone]] | Moderate | Low | Intermediate | ★ | 
-  * ↓ cytokines (IL-1, IL-2, IL-4, IL-5, IL-6, TNF-α) +| [[endocrine:drugs:prednisolone|Prednisolone]] | Moderate | Low | Intermediate | ★ | 
-  * ↓ phospholipase A2 → ↓ prostaglandins + leukotrienes +| [[endocrine:drugs:methylprednisolone|Methylprednisolone]] | Moderate–High | Minimal | Intermediate | ★ | 
-  * ↓ eosinophils, ↓ T-cell activation +| [[endocrine:drugs:triamcinolone|Triamcinolone]] | Moderate–High | None | Intermediate |  | 
- +| [[endocrine:drugs:dexamethasone|Dexamethasone]] | High | None | Long | ★ | 
-Full pathway: +| [[endocrine:drugs:betamethasone|Betamethasone]] | High | None | Long | ★ |
-  * [[endocrine:physiology:glucocorticoid_signaling|Glucocorticoid Signaling Pathway]]+
  
 ---- ----
  
-===== Systemic Glucocorticoids ===== +===== Inhaled Glucocorticoids =====
-These are used for systemic inflammatory and immune-mediated disease.+
  
-^ Drug ^ Duration ^ Notes ^ +^ Drug ^ Notes ^ ★ ^ 
-| [[endocrine:drugs:hydrocortisone|Hydrocortisone]] | Short | Higher mineralocorticoid activity | +| [[endocrine:drugs:beclomethasone|Beclomethasone]] | Early ICS |  | 
-| [[endocrine:drugs:cortisone|Cortisone]] | Short | Less commonly used | +| [[endocrine:drugs:budesonide|Budesonide]] | Also GI-targeted form | ★ | 
-| [[endocrine:drugs:prednisone|Prednisone]] | Intermediate | Common oral outpatient steroid (prodrug) | +| [[endocrine:drugs:ciclesonide|Ciclesonide]] | Prodrug activated in lung |  | 
-| [[endocrine:drugs:prednisolone|Prednisolone]] | Intermediate | Active form (preferred in severe liver disease) | +| [[endocrine:drugs:flunisolide|Flunisolide]] | Less common |  | 
-| [[endocrine:drugs:methylprednisolone|Methylprednisolone]] | Intermediate | Minimal mineralocorticoid activity | +| [[endocrine:drugs:fluticasone|Fluticasone]] | Most commonly used | ★ | 
-| [[endocrine:drugs:triamcinolone|Triamcinolone]] | Intermediate | Often intra-articular/topical use | +| [[endocrine:drugs:mometasone|Mometasone]] | Long pulmonary retention |  | 
-| [[endocrine:drugs:dexamethasone|Dexamethasone]] | Long | High potency, no mineralocorticoid activity | + 
-| [[endocrine:drugs:betamethasone|Betamethasone]] | Long | High potency; common in obstetrics & derm |+Used in: 
 +  * [[respiratory:clinical:asthma|Asthma]]
  
 ---- ----
  
-===== Inhaled Corticosteroids ===== +===== Intranasal Glucocorticoids =====
-Used primarily in: +
-  * [[respiratory:clinical:asthma|Asthma]]+
  
-  * [[endocrine:drugs:beclomethasone|Beclomethasone]] +^ Drug ^ Notes ^ ★ ^ 
-  * [[endocrine:drugs:budesonide|Budesonide]] +| [[endocrine:drugs:beclomethasone|Beclomethasone]] | Also inhaled |  | 
-  * [[endocrine:drugs:ciclesonide|Ciclesonide]] +| [[endocrine:drugs:budesonide|Budesonide]] | Also inhaled | ★ | 
-  * [[endocrine:drugs:flunisolide|Flunisolide]] +| [[endocrine:drugs:flunisolide|Flunisolide]] | Less common |  | 
-  * [[endocrine:drugs:fluticasone|Fluticasone]] +| [[endocrine:drugs:fluticasone|Fluticasone]] | First-line congestion therapy | ★ | 
-  * [[endocrine:drugs:mometasone|Mometasone]]+| [[endocrine:drugs:mometasone|Mometasone]] | High potency |  | 
 +| [[endocrine:drugs:triamcinolone|Triamcinolone]] | OTC option |  |
  
----- 
- 
-===== Intranasal Corticosteroids ===== 
 Used in: Used in:
   * [[allergy:clinical:allergic_rhinitis|Allergic Rhinitis]]   * [[allergy:clinical:allergic_rhinitis|Allergic Rhinitis]]
- 
-  * [[endocrine:drugs:beclomethasone|Beclomethasone]] 
-  * [[endocrine:drugs:budesonide|Budesonide]] 
-  * [[endocrine:drugs:flunisolide|Flunisolide]] 
-  * [[endocrine:drugs:fluticasone|Fluticasone]] 
-  * [[endocrine:drugs:mometasone|Mometasone]] 
-  * [[endocrine:drugs:triamcinolone|Triamcinolone]] 
  
 ---- ----
  
-===== Topical Dermatologic Corticosteroids =====+===== Topical Dermatologic Glucocorticoids ===== 
 + 
 +^ Drug ^ Typical Potency ^ ★ ^ 
 +| [[endocrine:drugs:hydrocortisone|Hydrocortisone]] | Low | ★ | 
 +| [[endocrine:drugs:desonide|Desonide]] | Low–Moderate |  | 
 +| [[endocrine:drugs:triamcinolone|Triamcinolone]] | Moderate | ★ | 
 +| [[endocrine:drugs:betamethasone|Betamethasone]] | High | ★ | 
 +| [[endocrine:drugs:fluocinonide|Fluocinonide]] | High |  | 
 +| [[endocrine:drugs:clobetasol|Clobetasol]] | Very High | ★ | 
 Used in: Used in:
   * [[dermatology:clinical:atopic_dermatitis|Atopic Dermatitis]]   * [[dermatology:clinical:atopic_dermatitis|Atopic Dermatitis]]
   * [[dermatology:clinical:contact_dermatitis|Contact Dermatitis]]   * [[dermatology:clinical:contact_dermatitis|Contact Dermatitis]]
- 
-Common examples (varied potency): 
-  * [[endocrine:drugs:hydrocortisone_topical|Hydrocortisone (topical)]] 
-  * [[endocrine:drugs:triamcinolone_topical|Triamcinolone (topical)]] 
-  * [[endocrine:drugs:betamethasone_topical|Betamethasone (topical)]] 
-  * [[endocrine:drugs:clobetasol|Clobetasol]] (very high potency) 
-  * [[endocrine:drugs:fluocinonide|Fluocinonide]] 
-  * [[endocrine:drugs:desonide|Desonide]] 
- 
-(Topicals are best organized by potency classes I–VII on a dedicated page.) 
  
 ---- ----
  
-===== Ophthalmic Corticosteroids ===== +===== GI-Targeted Glucocorticoids =====
-Used for ocular inflammation (under ophthalmology guidance).+
  
-  * [[endocrine:drugs:prednisolone_ophthalmic|Prednisolone (ophthalmic)]] +^ Drug ^ Notes ^ ★ ^ 
-  * [[endocrine:drugs:dexamethasone_ophthalmic|Dexamethasone (ophthalmic)]] +| [[endocrine:drugs:budesonide|Budesonide]] | High first-pass metabolism | ★ | 
-  * [[endocrine:drugs:loteprednol|Loteprednol]] +| [[endocrine:drugs:hydrocortisone|Hydrocortisone]] | Rectal formulations |  |
- +
-----+
  
-===== GI / Rectal Corticosteroids ===== 
 Used in: Used in:
   * [[gastroenterology:clinical:ibd|Inflammatory Bowel Disease]]   * [[gastroenterology:clinical:ibd|Inflammatory Bowel Disease]]
- 
-  * [[endocrine:drugs:budesonide|Budesonide]] (high first-pass; GI targeting) 
-  * [[endocrine:drugs:hydrocortisone_rectal|Hydrocortisone (rectal)]] 
  
 ---- ----
  
 ===== Mineralocorticoids ===== ===== Mineralocorticoids =====
-These are primarily aldosterone-like (volume/BP support), not anti-inflammatory. 
- 
-  * [[endocrine:drugs:fludrocortisone|Fludrocortisone]] 
  
-Clinical context: +^ Drug ^ Primary Use ^ ★ ^ 
-  * [[endocrine:clinical:adrenal_insufficiency|Adrenal Insufficiency]]+| [[endocrine:drugs:fludrocortisone|Fludrocortisone]] | Adrenal insufficiency | ★ |
  
 ---- ----
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 Short-term: Short-term:
   * Hyperglycemia   * Hyperglycemia
-  * Mood changes / insomnia +  * Mood changes 
-  * Increased appetite +  * Insomnia 
-  * Fluid retention (more with mineralocorticoid-active agents)+  * Fluid retention (more with mineralocorticoid activity)
  
 Long-term: Long-term:
   * HPA axis suppression   * HPA axis suppression
   * Osteoporosis   * Osteoporosis
 +  * Myopathy
   * Increased infection risk   * Increased infection risk
 +  * Skin thinning
   * Cataracts / glaucoma   * Cataracts / glaucoma
-  * Skin thinning, poor wound healing 
-  * Myopathy 
  
-HPA physiology:+See:
   * [[endocrine:physiology:hpa_axis|HPA Axis Physiology]]   * [[endocrine:physiology:hpa_axis|HPA Axis Physiology]]
- 
----- 
- 
-===== Clinical Integration (Link Out) ===== 
- 
-  * [[allergy:clinical:allergic_rhinitis|Allergic Rhinitis]] 
-  * [[respiratory:clinical:asthma|Asthma]] 
-  * [[rheumatology:clinical:rheumatoid_arthritis|Rheumatoid Arthritis]] 
-  * [[gastroenterology:clinical:ibd|Inflammatory Bowel Disease]] 
-  * [[dermatology:clinical:atopic_dermatitis|Atopic Dermatitis]] 
  
 ---- ----
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 ===== High-Yield Pearls ===== ===== High-Yield Pearls =====
  
-  * Systemic steroids suppress the HPA axis with prolonged use. +  * Dexamethasone and betamethasone have no mineralocorticoid activity. 
-  * Dexamethasone and betamethasone have **no mineralocorticoid activity**.+  * Inhaled steroids are foundational therapy in asthma.
   * Intranasal steroids are first-line for allergic rhinitis congestion.   * Intranasal steroids are first-line for allergic rhinitis congestion.
-  * Inhaled steroids are foundational in asthma control. +  * Chronic systemic use suppresses ACTH. 
-  * In anaphylaxis, epinephrine is first-line; steroids are adjunctive.+  * One molecule = one page; routes described within drug monographs.
endocrine/drug_classes/corticosteroids.1770926308.txt.gz · Last modified: by andrew2393cns