Corticosteroids are drugs/medications widely used in several areas of medicine. They are also known as glucocorticoids, cortisone and colloquially steroids (note: do not mix up with anabolic steroids).
They are synthetic analogs of naturally occurring endogenous steroids produced by the adrenal cortex. In practice, corticosteroids are used for their glucocorticoid effects. Pertinent to interventional procedures, some corticosteroid medications are particulate (e.g. Celestone) and frequently avoided in spinal interventions due to the potential risk of embolization and consequent infarction.
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Mechanism of action
In essence, corticosteroids have anti-inflammatory and immunosuppressive effects. They also affect fluid movement, electrolytes, blood sugar and central nervous system.
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genomic mechanism of action
acts on intracellular receptors in the cytoplasm that inhibit gene expression and translation for inflammatory white cells
reduces proinflammatory chemokines and cytokines
reduce cell adhesion molecules
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non-genomic mechanism of action
inhibition of phospholipase (A2), which produces inflammatory cytokines
impair the release of arachidonic acid
regulate apoptosis
at high concentrations, inhibit B and T cell production
Administration
topical: ointments, creams, eye drops
oral
inhaled
intramuscular
intravenous
intradermal
subcutaneous
intra-articular
intralesional
Complications
osteoporosis, osteonecrosis, and fractures
adrenal suppression
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Cushingoid features
redistribution of fat (i.e. moon-like facies, buffalo hump)
diabetes mellitus and insulin resistance
proximal myopathy and weakness
psychosis
agitation
insomnia
immunosuppression