DRUG STUDY AND INFORMATION FORM Generic Name: Glucocorticoids Trade Name: Prednisone, Dexamethasone Drug Class: Glucocorticoids

Structure/Chemistry: Prednisone Dexamethasone

Pharmacodynamics

Mechanism of Action: Glucocorticoids act through their binding to a specific physiological receptor that translocates to the nucleus and induces anti-proliferative and apoptotic responses in sensitive cells.

Pharmacologic Effects: Cytotoxic agents due to their lympholytic effects and their ability to suppress mitosis in lymphocytes

Drug Resistance or Tolerance: Remissions occur more frequently than with anti-metabolites (therefore, glucocorticoids are usually coupled with anti-metabolites often followed by an anthracycline or methotrexate and L-asparaginase). Acute changes in dexamethasone dosage can lead to a rapid recrudescence of symptoms.

Pharmacokinetics

Absorption: Prednisone is given orally in doses as high as 60-100 mg or even higher for the first few days but gradually reduced to around 20-40 mg/day. Dexamethasone is given orally Distribution:

Elimination: Dexamethasone t1/2 of 36-54 hours. Prednisone t1/2 of 1 hour.

Metabolism:

Adverse Side Effects/Toxicity: Drug Interactions: Used in combination with radiotherapy to prevent edema in critical areas (brain)

Therapeutic uses: Acute leukemia in children and malignant lymphoma in children and adults. A valuable component for curative regimens of other malignancies (Hodgkins disease, nonHodgkins lymphoma, multiple myeloma, and chronic lymphocytic leukemia). Helpful in controlling auto-immune hemolytic anemia and thrombocytopenia associated with CLL. Provides temporary restoration of neurological function from cerebral metastases (do not discontinue dexamethasone in patients with brain metastases). Dexamethasone is preferred for multiple myeloma remission, in combination with melphalan, anthracyclines, vincristine, bortezomib, or thalidomide. Miscellaneous: