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Note:

Topical Steroid, ICS (’onide’, ‘asone’), Joint Asporation are created as a separate entry due to its different A/E profile

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Caution

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• Consider “end point” before introduction.
• Consider what biomarkers and clinical features will be used to monitor response and indicate when dose can be reduced. </aside>

Options

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Dosing

• Prednisone 5 mg = Hydrocortisone 20 mg = Methylprednisolone 4 mg

  • https://www.mdcalc.com/calc/2040/steroid-conversion-calculator

• Rough Dosage in (in Prednisone, mg)

  Low dose	15
  Medium	20-40
  High	40

• The sicker the patient, the higher the dose

• Sometimes use “pulses” of very high dose steroid IV to treat life-threatening complications

MOA

1. Direct genomic effects: GC bind to intracellular receptor and the complex moves to the nucleus → facilitating or inhibiting transcription of certain genes.
2. Indirect genomic effects: GC-Receptor complex interaction with other transcription factors, such as nuclear factor-kB (NF-kB) → affect downstream expression
3. Non-genomic pathways: GC signaling through membrane-associated receptors and second messengers.
4. There is also a nonspecific, nongenomic membrane effect at high doses

Effect

• ST anti-inflammatory and immunomodulatory
  • Alter immune cell function
  • Inhibit leukocyte access to inflamed tissues
  • Suppress the production of humoral factors such as cytokines and prostaglandins