Side Effects of Glucocorticoids

Study Notes

Patients should expect common early adverse effects, such as sweatiness, hoarse voice, loss of appetite, and stimulation.
Rarely, more serious acute psychiatric disturbances can occur, including agitation, aggression, or psychosis.
Long-term and less reversible adverse effects include Cushingoid appearance, proximal myopathy, hypertension, hyperlipidaemia, diabetes, cataract formation, peptic ulceration, osteopenia, and aseptic necrosis of bone.

Cytostatics inhibit cell division and are used in immunotherapy in smaller doses than in the treatment of malignant diseases.
They affect the proliferation of both T cells and B cells.
Examples of cytostatics include alkylating agents (e.g., cyclophosphamide), antimetabolites (e.g., folic acid analogues, purine analogues), and cytotoxic antibiotics (e.g., dactinomycin, anthracyclines, mitomycin C, bleomycin, mithramycin).

Antibodies are used for quick and potent immunosuppression to prevent acute rejection reactions.
There are two types of antibodies: polyclonal antibodies and monoclonal antibodies.
Polyclonal antibodies inhibit T lymphocytes, cause their lysis, and affect all lymphocytes, leading to general immunosuppression and possibly post-transplant lymphoproliferative disorders or serious infections.
Monoclonal antibodies are directed towards exactly defined antigens and cause fewer side effects.

Immunosuppressive drugs reduce the activation or efficacy of the immune system.
They are used to control severe manifestations of allergic, autoimmune, and organ transplant-related diseases.
Examples of immunosuppressive drugs include glucocorticoids, cytostatics, and antibodies.

Immunosuppressive drugs can be classified into three major groups: glucocorticoids, cytostatics, and antibodies.

Glucocorticoids act by inhibiting genes that code for cytokines IL-1, IL-2, IL-3, IL-4, IL-5, IL-6, IL-8, and TNF-γ.
Examples of glucocorticoids include prednisolone, azathioprine, mycophenolate, and methotrexate.

Monoclonal antibodies are directed towards exactly defined antigens and cause fewer side effects.
Examples of monoclonal antibodies include muromonab-CD3, Basiliximab, daclizumab, rituximab, and alemtuzumab.

Monoclonal antibodies are produced in multiple myeloma where only one clone secretes a particular type of antibody.
In the laboratory, monoclonal antibodies can be generated by hybridoma technology.
The process of hybridoma technology involves injecting an antigen into mice, fusing spleen cells from immunized mice with mice myeloma cells, and using polyethylene glycol as a fusion agent.