Question 11

Compare and contrast hydrocortisone, methylprednisolone and dexamethasone.

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College Answer

Hydrocortisone represents the main endogenous glucorticoid. Methylprednisolone and
dexamethasone are synthetic glucocorticoids that all have metabolic, anti – inflammatory and
immunosuppressive effects. These are commonly encountered drugs in intensive care practice,
yet overall this question was poorly answered. For a good answer candidates were expected to
mention the differences in their pharmacokinetics, relative glucocorticoid and mineralcorticoid
effects and adverse effects. These drugs share some common features (eg all have a steroid
nucleus, hepatic metabolism and renal excretion and adverse effects), features that were poorly
covered by the candidates, but also expected to be mentioned for a good answer.
Syllabus: N2,2c
References: Stoelting, Pharmacology and Physiology in Anaesthetic Practice, pge 416, Peck Hill
and Williams Pharmacology for Anaesthesia and Intensive Care, pg 355-8