안녕하세요 닥터부입니다.
오늘은 코르티코스테로이드제 약물에 대해 정리해보겠습니다.
정의 definition
코르티코스테로이드[ corticosteroid ]는 보통 스테로이드라 불리는 화학물질들입니다.
신장 위에 위치한 부신피질이라는 곳에서 코르티코스테로이드 화학물질을 생성하합니다. 뇌의 흥분능력과 신경전달물질의 물질대사 모두에 영향을 줍니다. 부신에서 생성되는 다른 화학물질들처럼 코르티코스테로이드도 필요할 경우에 분비되어 신체에 여분의 힘과 체력을 공급합니다.
한편, 보통으로 코르티코스테로이드는 가장 많이 사용되는 일반적인 보조 진통제로 강력한 항염증약의 일종입니다. 또한 글루코코르티코이드(glucocorticoid), 코르티손, 프레드니손(prednisone)으로도 불립니다. 일반적으로 류머티스성 관절염, 루프스, 혈관염 같은 질병을 치료하기 위해 사용됩니다. 부신 피질 호르몬 스테로이드의 일종인 프레드니솔론,(prednisolone), 하이드로코르티손(hydrocortisone)이 있습니다.
약물 투여 방법 drug injection
코르티코스테로이드는 다음과 같이 투여될 수 있습니다.
Corticosteroids may be given as follows:
정맥으로 투여(정맥 내—특히 응급 상황 시)
Administered by vein (intravenously—especially in an emergency)
경구 복용(경구 투여)
taken by mouth (oral administration)
염증 부위에 직접 도포(국소적으로, 예를 들어 점안액 또는 피부 크림으로)
Apply directly to the inflamed area (topically, for example with eye drops or skin cream)
흡입(폐를 위한 흡입형 버전으로, 천식, COPD 등의 질환 치료에 사용)
Inhalation (inhaled version for the lungs, used to treat diseases such as asthma and COPD)
근육에(근육내) 주사
Injection into a muscle (intramuscular)
관절 내로 주사
injection into the joint
부작용 side effect
부작용으로는 투여받는 환자들 중 특정한 부위에 피가 돌지 않아서 뼈가 죽는 무혈성 괴사가 발생하는 경우가 있습니다.
코르티코스테로이드를 투여하게 되면 혈중 지방 농도가 올라가고 그로 인해 생긴 지방 충전물들이 긴 뼈의 소동맥을 막고 혈류의 흐름을 방해하게 되어 피가 공급되지 않아 뼈가 괴사합니다.
또다른 부작용은 백내장, 우울증, 스테로이드에 의한 정신이상 등이 있습니다.
Side effects include bloodless necrosis in certain areas of the patients being administered, where the bones die due to lack of blood circulation.
The administration of corticosteroid increases blood fat levels, and the resulting fat fillings block the small arteries of the long bones and obstruct the flow of blood, resulting in the necrosis of the bones due to lack of blood supply.
Other side effects include cataracts, depression and steroid-induced psychosis.
문제 question
An 8-year-old boy is brought to the pediatrician by his parents for recurrent episodes of wheezing for the last 2 years. He uses a salbutamol inhaler for relief from wheezing, but his symptoms have recently worsened. He often coughs during the night, which awakens him from sleep almost every other day. He is not able to play football because he starts coughing after 10–15 minutes of play. His current physical examination is completely normal and auscultation of his chest does not reveal any abnormal breath sounds. His peak expiratory flow rate (PEFR) is 75% of expected for his age, gender, and height. After a complete diagnostic evaluation, the pediatrician prescribes a low-dose of inhaled fluticasone daily for at least 3 months. He also mentions that the boy may require continuing inhaled corticosteroid therapy for a few years if his symptoms recur after discontinuing the medication. However, his parents are concerned about the side effects of corticosteroids. Which of the following corticosteroid-related adverse effects is most likely?
A. Posterior subcapsular cataract
B. Suppression of hypothalamus-pituitary-adrenal (HPA) axis
C.Steroid psychosis
D. Hoarseness of voice
E. Short stature
Explanation:
Correct answer D: The most common side effects associated with inhaled corticosteroids are oropharyngeal candidiasis and hoarseness. Inhaled corticosteroids have significantly fewer side effects than oral or parenteral corticosteroids because they act topically on the airways directly and systemic absorption is negligible. Therefore, the side effects commonly associated with oral/parenteral corticosteroids are less likely to occur with inhaled corticosteroids. They act by inhibiting the synthesis of various cytokines, inhibiting the transcription factor NF-κB, reducing airway inflammation, reversing mucosal edema in the airways, decreasing capillary permeability, and inhibiting the release of leukotrienes. They also reduce bronchial hyperreactivity and airway smooth muscle hyperresponsiveness to various allergens, irritants, exercise, and cold air.
Inhaled corticosteroids are the most effective controller medications for the treatment of persistent asthma. They decrease bronchial hyperreactivity, effectively control symptoms, and reduce asthma exacerbations and asthma-related hospitalizations. The most important side effect of inhaled corticosteroids is oropharyngeal candidiasis, which occurs as a result of the deposition of the drug in the oropharyngeal mucosa. This effect can be prevented by rinsing the oral cavity with water after each use. Deposition of the drug on the vocal cords may cause hoarseness. Although systemic side effects, such as suppression of the hypothalamic-pituitary-adrenal (HPA) axis, are possible with the use of inhaled corticosteroids, they only occur after prolonged use of high-doses of the medication. The incidence of systemic side effects is negligible with inhaled corticosteroids when compared with oral corticosteroids.
Option A: A posterior subcapsular cataract is not the most likely side effect associated with the use of low-dose inhaled corticosteroids, but may occur with the use of oral corticosteroids.
Option B: Suppression of the HPA axis occurs in patients who are prescribed long-term systemic corticosteroids, but does not occur with inhaled corticosteroids.
Option C: Steroid psychosis and short stature are not the most likely side effects associated with the use of low-dose inhaled corticosteroids. The development of corticosteroid-induced psychosis is dependent on the dose of systemic corticosteroids. Corticosteroid-induced psychosis commonly occurs in patients taking >40 mg of prednisone or the equivalent every day.
Learning objective: The most common side effects associated with inhaled corticosteroids are oropharyngeal candidiasis and hoarseness. Inhaled corticosteroids have significantly fewer side effects than systemic corticosteroids because they act topically on airways and systemic absorption is negligible.
Related Videos:
Corticosteroids02:03 min
Book References:
First Aid for the USMLE Step 1 (2020, 30th ed): 687
First Aid for the USMLE Step 1 (2018, 28th ed): 649
First Aid for the USMLE Step 1 (2017, 27th ed): 668
First Aid for the USMLE Step 1 (2019, 29th ed): 672
First Aid for the USMLE Step 1 (2021, 31st ed):
참고자료
[네이버 지식백과] 코르티코스테로이드 (시사상식사전, pmg 지식엔진연구소)
[네이버 지식백과] 코르티코스테로이드 [corticosteroid] (과학용어사전, 2010. 4. 14., 뉴턴편집부, 현춘수)
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