Core IM | Internal Medicine Podcast #129 Steroids: 5 Pearls Segment
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Jun 28, 2023 From choosing between hydrocortisone, prednisone, and dexamethasone to spotting steroid side effects, this discussion tackles the practical puzzles of corticosteroid use. It covers infection and bone-protection strategies, when short courses can stop abruptly, and why longer treatment or repeated bursts may call for a careful taper.
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Steroid Spectrums
- Glucocorticoid activity (anti-inflammatory effect) and mineralocorticoid activity (salt/water retention) exist on opposite spectrums.
- High glucocorticoid activity usually means low mineralocorticoid activity, and vice-versa.
Choosing Steroids
- Consider glucocorticoid and mineralocorticoid activity when choosing steroids.
- Dexamethasone is best for emergencies needing anti-inflammatory effect, like spinal cord compression.
Minimizing HPA Suppression
- Choose steroids with the lowest potency and half-life for the indication to minimize HPA axis suppression.
- This reduces the risk of adrenal insufficiency.