Snapshot A 68-year-old woman with a past medical history of polymyalgia rheumatica and migraines presents with sudden-onset, left-sided headache with radiation to her jaw. She reports that this pain is not like her usual migraine pain. Laboratory testing reveals an elevated erythrocyte sedimentation rate. She is started on high-dose steroids to prevent permanent damage to her vision. (Giant cell arteritis) Overview Drugs systemic methylprednisolone dexamethasone prednisone hydrocortisone topical triamcinolone hydrocortisone clobetasol betamethasone inhaled fluticasone budesonide this list is not an exhaustive list as there are many different steroid options, particularly topical options Mechanism of action broad immunosuppressive effect, inhibiting multiple steps in the immune activation pathway inhibits phospholipase A2, which prevents formation of arachidonic acid inhibits NF-kB which is the transcription factor that results in production of inflammatory agents, including TNF-alpha inhibition of cyclooxygenase-2 this result in ↓ leukotrienes, prostaglandins, and prostacyclins Clinical use any inflammatory process drug reaction with eosinophilia and systemic symptoms (DRESS) vasculitis thyroid storm inflammatory bowel disease autoimmune diseases cauda equina syndrome immunosuppression cancer chemotherapy Addison disease asthma Adverse effects hyperglycemia diabetes bone loss osteoporosis vertebral fractures aseptic hip necrosis ↓ skeletal growth in children Cushing syndrome buffalo hump moon facies truncal obesity thin skin striae acne psychiatric symptoms findings anxiety panic attacks insomnia agitation mania psychosis management reducing the dose tertiary adrenal insufficiency acute pancreatitis lymphopenia ↓ wound healing cataracts