PHARMACOLOGICAL OF

CORTICOSTEROID

dr. Truly Sitorus,MSi

Department of Pharmacology & Therapy

Medical Faculty of Padjajaran University
 INTRODUCTION
bacteria infection
trauma

Tissue inflammation
(gum, articular)

Symptom : pain
edema
trismus
 INTERVENTION OF PHARMACOLOGY

Bacteria infection Antibiotics

Inflammation Antiinflammatory
process NSAIDs
Corticosteroid

Symptom
Analgesic
Pain
NSAIDs
trismus
INTRODUCTION CORTICOSTEROID

GLUCORTICOID
MINERALOCORTICOID
-Metabolic effect
Retension of Na-H2O
-Antiinflamatorry/
Immunosupresive BP, Edema
 CORTICOSTEROID
Is a hormone produced by cortex adrenal
gland

CORTISOL
Is a endogenous corticosteroid
It may interact with 2 receptor
- Glucocorticoid receptor
- Mineralocorticoid receptor
The receptor are in intracellular
 CORTICOSTEROID
SYNTHESIS

1. PREDNISONE
2. PREDNISOLONE
3. METHYL PREDNISOLONE
4. DEXAMETHASONE
MECHANISM OF ACTION OF CS

Corticosteroid
Modify the
transcription of RNA

Produced a specific
protein

Eg. : inhibit enzyme

induce enzyme
EFFECT-SIDE EFFECT OF CORTICOSTEROID

1. On inflammatory cells
decreased number and activity of
leukocyte
(neurophils, macrophages)
decreased activity of :
- monoclear cells
- fibroblast
- T helper cells
EFFECT-SIDE EFFECT OF CORTICOSTEROID

2. On inflammatory and immune mediators

decreased production and activity of
cytokine (IL, TNF)
decreased production of : PG
IgG
histamine

- What are the advantages of these effect?

- And what are the disadvantages?
EFFECT-SIDE EFFECT OF CORTICOSTEROID

CORTICOSTEROID

On vascular
On cellular event
Vasodilatation
-Area of acute Inflammation
N and A of Leucocytes
Others
-Area of Chronis Inflammation
IL Lymphopid tissue
Activity of mononuclear cells
PAF - Clonal expansion
of T and B cells fibroblast function
Histamine
- Action of cytocine
EFFECT-SIDE EFFECT OF CORTICOSTEROID

3. On metabolic regulation
on carbogydrates
gluconeogenesis
Blood
uptake of glucose glucose

on protein
catabolism of protein ATROPHY
- muscle (myopathy)
- skin atrophy
- osteoporosis
- lymphoid tissue atrophy
 EFFECT-SIDE EFFECT OF CORTICOSTEROID
Fat metabolism

Moon face

Buffalo
hump
Truncal obesity

Atrophy
 EFFECT-SIDE EFFECT OF CORTICOSTEROID

4. Gastric & duodenal ulcer

gastric juice production
gastric protection

5. Central nervous system

euphoria
insomnia, depression
 EFFECT-SIDE EFFECT OF CORTICOSTEROID

6. Endocrine
hirsutisme, amenorhoe
7. Osteoporosis
activity of osteoclast, and function of
osteoblast
Catabolic effect of protein
8. Growth retardation
 EFFECT-SIDE EFFECT OF CORTICOSTEROID

9. Eye
intraoccular pressure (glaucoma)
blind
10. Electrolite and water imbalance
retention of Na-water

blood pressure
edema
 PHARMACOKINETICS
Administration
Oral, injection
Topical (skin, eye, inhalation/aerosol)
Absorption : good
Distribution to all the tissue/cells
Metabolized : Liver
Excretion : Kidney
INDICATION OF CORTICOSTEROID IN
DENTISTRY

1. Inflammation process
Infection
Non infection
2. Chronic inflammation process
Arthritis of mandibula
3. Drugs Allergy (Hypersensitive)
INDICATION OF CORTICOSTEROID IN
DENTISTRY

1. Endocrine disorders
Therapy substitute for addison disease

2. Non endocrine disorders

- Asthma bronchiale
- Rheumatoid arthritis
- Rhinitis allergyca
- Excema
- Autoimmune disease (SLE, NS)
- Organ transplantation
 THE USE OF CORTICOSTEROID

DENTISTRY NON DENTISTRY

Short-term Short term

therapy therapy
Long- term
Long term ? therapy
2 weeks

SE
Withdrawal effect (raybound phenomena
Atrophy of cortex adrenal
 CONTRAINDICATION OF PREDNISON

CORTICOSTEROID

METABOLIC ELECTROLIC & WATER

- Glucose IMBALANCE
Retention of Na-water
- Deposition of lipid
BP
Gastric & duodenal ulcer Edema
Children growth

What are the contraindication of prednisone ?

 CONTRAINDICATION OF PREDNISON

What are the contraindication of prednisone ?

 COMPARISON OF THE MAIN CS DRUGS
DRUG EFFECT SE DOA
(antiinflammatori) Na-H2O retention hours

Hydrocortison 1 1 8-12
(cortisol)

Prednisone 4 0,8 12-36 S

Prednisolone 4 0,8 12-36 S

Methyl
5 Minimal 12-36 L
Prednisolone

Dexamethasone 30 Minimal/none 36-72

Which are the appropriate drug for patient with hypertension ?

REGIMEN DOSAGE OF CORTICOSTEROID

INVOLVING :
1. The dosage of the drug
2. The frequency of its administration
3. The timing of its administration
4. The duration of treatment
5. The ways of stopping the drugs
 REGIMEN DOSAGE OF CORTICOSTEROID

1. Dosage depends on indication and on

individual response

2. Whenever a single dosage is needed, it

should be given in early morning. In case
of divided dosage, high dosage in the
morning and low dosage at night should
be given
 REGIMEN DOSAGE OF
CORTICOSTEROID

3. When the glucorticoid therapy will be

stopped the dosage should be reduce
gradually over a period of weeks or
months (tapering off)