Name

Class

Hydrocortisone/cortisol Short-acting GCs

Mechanism of Use/Indications Action Anti-inflammatory Dermatologic and disorders immunosuppressive actions Anti-inflammatory and immunosuppressive actions Anti-inflammatory and immunosuppressive actions Greater use for topical, highly lipid soluble, more potent than prednisone More antiinflammatory effects Greater saltretaining activity Dermatologic disorders, autoimmunity, organ transplantation plus cyclosporine Dermatologic disorders

Contraindications

Side Effects

Route of Administration Oral, injectable, topical

Prednisone

Short-acting GCs

oral

Prednisolone

Short-acting GCs

Oral, injectable, topical

IntermediateTriamcinolone acetonide (budesonide, acting GCs fluticasone)

Asthma inhaler

Oral, injectable, topical

Dexamethasone

Long-acting GCs

Cerebral edema

Oral, injectable, topical

Fludrocortisone

Mineralocorticoid

Oral, injectable, topical

Spironolactone, Eplerenone

Mineralocorticoid antagonist

Competitive antagonist at MC receptor and androgen receptors; eplerenone selective aldosterone antagonist

Tx of aldosteronism, hirsutism, diuretic for tx of HTN

Hyperkalemia, metabolic acidosis, gynecomastia, impotence, BPH; eplerenone less androgen side effects

Mifepristone (RU486)

GC antagonist

Levothyroxine

Synthetic T4

Liothyronine

Synthetic T3

Propylthiouracil (PTU)

Thionamide (Anti-Thyroid Drugs)

131

Radioactive iodine

Progesterone and GC antagonist; binds GC receptor with higher affinity than dexamethasone; inactivates gene transcription Longer half-life; Advantages: precise dosage control, hypoallergenic, once daily dose Advantage: 4x more active than T4 Disadvantage: cardiotoxicity, multiple daily dosing Inhibit thyroid peroxidase, block tyrosine iodination on TG, iodotyrosine coupling, and peripheral deiodination of T4 to T3; short halflife and requires multiple daily dosing Only isotope used; half-life= 8 days; only thyroid is affected, avoid surg, inexpensive

Tx of cushings syndrome but not in this country; abortion drug

Tx of hypothyroidism; overall drug of choice

oral

oral

Tx of hyperthyroidism; 2nd line drug for patients allergic or unresponsive to methimazole

Tx of hyperthyroidism

Pregnancy

Rashes, fever, vasculitis, arthralgia, cholestatic jaundice, hepatitis, hypothyroidism after long-term use; agranulocytosis; increased risk of liver failure Delayed hypothyroidism, potential carcinogenicity; crosses placenta

Methimazole

Thionamide (Antithyroid drug)

Inhibit thyroid peroxidase, block tyrosine iodination on TG, iodotyrosine coupling, and peripheral deiodination of T4 to T3 Inhibits TH synthesis and release; rapid acting

Tx of hyperthyroidism; 1st line drug

Rashes, fever, vasculitis, arthralgia, cholestatic jaundice, hepatitis, hypothyroidism after long-term use; agranulocytosis Not suitable for long-term tx bc gland adapts and will produce more TH in response to long-term increased use of Iodide

KI (potassium iodide)

Iodide

Tx of hyperthyroidism; acute, short-term use for reducing size of thyroid prior to surgery