April Merrill, MS, APRN, CCNS
 Identify
the different categories of steroid
medications
 Identify
 Identify
the uses for steroid medications
side-effects and precautions for
steroid medications

Hormones- secreted by cells to regulate the
activity of other cells.
Growth
 Development
 Behavior
 Reproduction

Coordinates the production, use and storage of
energy.
 Homeostasis

Nutrition
 Metabolism
 Excretion
 Water and salt balance

 The
term steroid refers to any synthetic
(man made) or naturally occurring fat (lipid)
soluble compound that has a physiological
response.
 Steroids
are hormones derived from
cholesterol and differ only in the ring
structure and side chains attached to it.
Adrenalcortical steroids
 Progesterone & related steroids
 Androgens
 Estrogens
 Bile acids & bile salts
 Cholesterol


Progestogens (also known a progestins) such as
progesterone


Produced from the corpus luteum in normal menstrual
cycle
Estrogens, including estradiol and estrone

produced primarily by developing follicles in the
ovaries, the corpus luteum, and the placenta
promote the development of female secondary
sexual characteristics, such as breasts
 involved in the thickening of the endometrium
and other aspects of regulating the menstrual
cycle.

 Testosterone

primarily secreted in the testes of males and the
ovaries of females
 plays
a key role in the development of male
reproductive tissues such as the testis and
prostate
 promotes secondary sexual characteristics
such as increased muscle, bone mass and the
growth of body
 Prevents osteoporosis
Roids
Juice
Sauce
Sloop

Natural ~ Bioactive Molecules

promote cell division/ growth

Testosterone

Estrogen

Cholesterol
http://en.wikipedia.org/wiki/Testosterone
http://en.wikipedia.org/wiki/Cholesterol
 Structural

Not found in nature.
 How



Definition
they are prepared.
Semi-synthetic
Natural Source Materials
Synthetic Chemistry Derivation
 Advantages


Cost
Highly variable structure

Anabolic steroids are synthetic versions of
testosterone, the body’s natural sex hormone.
They assist athletes by facilitating efforts to gain
strength and muscle mass for increased muscular
endurance, power and speed.
Stimulation of:







Sexual development
Growth
Puberty
Bone marrow
Appetite
Muscle Mass
Stamina
http://www.steroidabuse.com/how-anabolic-steroids-work.html

Hormonal System


Short stature

Tendon rupture
Infertility




Cardiovascular System
Breast development
Shrinking of the testicles
Women


Enlargement of the clitoris
Excessive growth of body
hair



Men


Muscoloskeletal System

Heart attacks

Enlargement of the left ventricle
Liver

Cancer

Peliosis hepatis
Skin
Both Sexes

Male-pattern baldness

Acne and cysts

Oily scalp

Altered hormone levels

Inability to control behavior

Severe mood swings

Irritability

Violent aggression

Depression
 Oral
 Injection


Sanitation
Intramuscular injection

Avoidance
Nerves
 Blood vessels


Sites



Deltoid in upper arm
Outer thigh
Buttocks
 Is
it cheating?
 Is
it legal?
 Is
it worth it?
 Nandrolone
decanoate- 18 mos.
 Depo-testosterone Parabolan Andriol-
5 weeks
1 week
 Clenbuterol-
4 days
3 mos.
 Oral

Oxymetholone

Oxandrolone

Methandrostenolone

Stanozolol
 Injectable

Nandrolone
decanoate

Nandrolone
phenpropionate
Testosterone
cypionate

Boldenone
undecyclenate

Dosage- 8-16 40 mg caps daily

Street price- $1 for 40 mg

Half-life: 3-5 hrs

Dose- 200-400 mg daily

$2-3 per 200 mg cap

Lack of popularity


Slightly androgenic
Expensive
 Dosage:
25-50 mg/ day
 Price: 2 50 mg tablets for $1
 First oral steroid
 Works well; bad side effects and high cost
 Potent androgen

Prone to ‘roid rage’
 Dosage:
250-1000 mg/ week
 Price: $10-30/ ml
 Stacks well with any compound
 Extreme anabolic tendencies

Good and bad
 Injectables
 www.steroid.com
 www.bodybuilding.com
 www.steroidworld.com
 www.wikipedia.com
 www.wrestlingusa.com
 www.anabolicsmall.com
 www.steroids.com
 www.pharmaeurope.com
 Glucocorticoids

cortisol
controls carbohydrate, fat and protein
metabolism
anti-inflammatory by preventing phospholipid
release, decreasing eosinophil action
 Mineralocorticoids-aldosterone

controls electrolyte and water levels, mainly by
promoting sodium retention in the kidney.
Prednisone (Deltasone)
 Methylprednisolone (Solumedrol IM/IV)
 Cortisone
 Betamethasone (Diprolene)
 Dexamethasone (Decadron)
 Hydrocortisone (Solucortef IM/IV)
 Prednisolone
 Triamcinolone (Azmacort, Nasacort, Kenalog)
 Fluticasone (Flovent, Flonase, Advair*)
 Budesonide (Pulmicort, Rhinocort, Symbicort*)

* Combination product
 Replacement;
Addison’s disease (low dose)
 Non-endocrine (high dose)
Rheumatoid arthritis / SLE / other inflammation
(po, intra-articular injection)
 Asthma (oral, inhaled, IV)
 Inflammatory bowel disease
 Allergic responses
 Dermatologic (topical, oral)
 Cancers
 Organ transplant (immune system suppression)
 Respiratory support in preterm infants
 Decrease cerebral edema (suppress
inflammation)

 Background/overview
 Metabolism
 Mineralocorticoid
effect (sodium retention)
 Anti-inflammatory
 Immunosuppressant
 Adrenal
insufficiency
 Osteoporosis
 Infection
 Glucose intolerance
 Muscle wasting
 Fluid and
electrolyte
imbalance

Edema, HTN, muscle
weakness,
dysrhythmias
 Growth
suppression
 Depression/suicide

“roid rage”
 Cataracts,
glaucoma
 Peptic ulcer
 Iatrogenic
Cushing’s
syndrome
 Thin skin
 Digoxin,
thiazide / loop diuretics due to
hypokalemia
 NSAIDs due to GI bleeding
 Insulin and oral hypoglycemics due to
hyperglycemia
 Vaccines due to immunosuppression

No live vaccines
 Need
for additional doses during stress if
replacement
 Tapering if not replacement

DO NOT ABRUPTLY STOP (with exceptions)
 Alternate

day dosing
Theoretically there is less endogenous
corticosteroid suppression (via feedback)
 Potency
can vary greatly between various
drugs, preparations (cream vs. ointment),
and routes of administration
 Systemic absorption also varies based on
route

Ex. Topical cream/ointment will have greater
systemic effect if skin broken vs. intact
On-line calculators:
http://www.globalrph.com/corticocalc.htm
http://www.medcalc.com/steroid.html
Class/Potency
Brand Name
Generic
CLASS 1—Superpotent
Clobex
Lotion/Spray/Shampoo,
0.05%
Clobetasol propionate
Diprolene Ointment,
0.05%
Betamethasone
dipropionate
Lidex
Cream/Gel/Ointment,
0.05%
Fluocinonide
Lidex-E Cream, 0.05%
Fluocinonide
Kenalog Cream/Spray,
0.1%
Triamcinolone acetonide
Capex Shampoo, 0.01%
Fluocinolone acetonide
CLASS 6—Mild
Aclovate
Cream/Ointment, 0.05%
Alclometasone
dipropionate
CLASS 7—Least Potent
Cortaid
Cream/Spray/Ointment
Hydrocortisone
CLASS 2—Potent
CLASS 3—Upper MidStrength
CLASS 4—Mid-Strength
CLASS 5—Lower MidStrength
http://www.psoriasis.org/NetCommunity/Page.aspx?pid=469
 Give
with food
 Give before 9 am to mimic circadian rhythm
 Contraindicated if systemic fungal infection
 Caution with pregnancy or lactation, HTN,
heart disease, renal failure, GI irritation, DM
 Questions????