Pain and Corticosteroids

• Na+ retaining
• Increased Na+ = increased H20 = increased volume
• Endogenous = aldosterone
• Synthetic = fludrocortisone

• Glucose retaining
• Endogenous = cortisol
• Regulation of fat, carbs, protein metabolism
• Naturally occurring = hydrocortisone and cortisone
• Synthetic = prednisone

Intracellular binding leads to DNA transcription--> effect lags behind dosage (takes a while to elicit a response)

• Inhibiting macrophage accumulation in inflamed areas
• Decreased capillary permeability and edema formation
• Antagonize histamine activity
• Decrease immunoglobulins and passage of immune complexes via basement memb
• Prevent release of destructive acid hydrolases from leukocytes

• Opioid agonist:
• Duragesic
• Fentora
• Actiq

• Opioid agonist:
• Vicodin
• Lorcet
• Lortab

• Opioid agonist:
• Dilaudid

• Opioid agonist:
• Demerol

• Opioid agonist:
• Dolophine

• Opioid agonist:
• MS Contin
• Oramorph
• Kadian, Avinza

• Opioid agonist:
• OxyContin

• Opioid agonist:
• Percocet
• Endocet

Darvon

Darvocet

• Opioid Partial Agonist/Antagonist:
• Suboxone

• Centrally acting analgesic:
• Ultram
• Ryzolt

• GC:
• Medrol
• Depo-Medrol
• Solu-Medrol

• GC:
• Short acting
• T1/2 8-12 hrs
• Na+ retaining
• No anti-inflammatory
• Equiv=25mg / 20 mg

• GC:
• Intermediate acting
• T1/2 18-36 hrs
• Moderate Na+ retaining (1)
• Mod anti-inflamm (4)
• Equiv=5mg

• GC:
• Intermediate acting
• T1/2 18-36 hrs
• No Na+ retaining
• Moderate anti-inflamm (5)
• Equiv=4mg

• GC:
• Intermediate acting
• T1/2 18-36 hrs
• No Na+ retaining
• Moderate anti-inflamm (5)
• Equiv = 4mg
• Dosepak (TAPER)

• GC:
• Long-acting
• T1/2 36-55 hrs
• No Na+ retaining
• HIGH anti-inflamm (20-30)
• Equiv=0.75

Decreased substrate in blood (drug removal)

Increased substrate in blood (no breakdown)

• Efflux transporter
• Excretion (decreased absorption)