Farmacología de los glucocorticoides

In this video, we review the pharmacology of glucocorticoid steroids, from dexamethasone and cortisone to inhaled steroids like budesonide. We cover their indications, mechanisms of action, adverse events, contraindications, and offer some practical tips. [00:00] Introduction to steroids, their relevance in reducing mortality from severe respiratory infections, and the three chemical groups. [01:57] Pharmacokinetic properties of lipid messengers, their various routes of administration, and the delayed onset of biological effect. [04:41] History of steroids: From the first animal adrenal extracts (1930) to the laboratory synthesis of molecular variants. [08:04] The hypothalamic-pituitary-adrenal axis, cortisol as a stress hormone, and the negative feedback mechanism. [09:23] The iatrogenic risk of drug-induced adrenal insufficiency and changes at the cellular genetic level. [11:24] Metabolic, immunological, and mineralocorticoid effects (sodium and water retention, insulin resistance, and short stature in children). [13:30] Classification of steroids according to their duration of action (short, intermediate, and long-acting) and their anti-inflammatory potency. [16:33] Main clinical indications (Addison's disease, asthma, skin, oncohematological, and rheumatological conditions, and fetal lung maturation). [20:41] Severe systemic adverse effects of glucocorticoid excess and clinical characteristics of Cushing's syndrome. [23:05] Risk factors for developing an adrenal crisis due to abrupt discontinuation of steroid treatment. [24:32] Contraindicated drug combinations (NSAIDs, immunosuppressants, live attenuated vaccines) and precautions in underlying conditions. [27:08] Clinical examples of dosage and maintenance regimens (Dexamethasone, Hydrocortisone, Inhaled Budesonide, and Prednisone). [29:18] Clinical pearls: Reactivation of latent infections, adjunctive use in sepsis, and the role of steroids in palliative care. [32:22] The clinical debate on the use of low-dose dexamethasone for Acute Respiratory Distress Syndrome (ARDS).