Introduction
In orthopedics, commonly used closed therapies include anesthetics and hormones. There are many hormones, such as dexamethasone and betamethasone, which can be quite overwhelming (next time at the talent show, let’s do a hormone version of naming dishes).
Questions
What is the relationship between these XX-sone and XX-solone drugs?
Why can hormone drugs reduce inflammation? How do they differ from non-steroidal anti-inflammatory drugs (NSAIDs)?
Main Text
First, let’s talk about hormone drugs. The human endocrine system secretes various hormones, such as glucocorticoids, mineralocorticoids, sex hormones, thyroid hormones, etc. Generally, the hormones referred to in clinical medications are glucocorticoids (GC).
If you don’t remember what glucocorticoids are, please see 【白学】简述肾上腺激素（肾上腺皮质激素、肾上腺髓质激素）
The main functions of GCs are:
- Regulation of metabolism (simply put, converting fats and proteins into sugars)
- The four major anti-effects (anti-inflammatory, anti-allergic, anti-endotoxin, anti-shock)
- Some regulation of water and salt metabolism (the glucocorticoids secreted by the human body are structurally similar to mineralocorticoids, so they have some mineralocorticoid functions; this will not be expanded here)
The adrenal glands secrete [[cortisone]], which is transported to the liver where it is activated to [[cortisol]]. Only cortisol can exert direct effects. To enhance half-life and increase lipid solubility, structural modifications were made to cortisone and cortisol.
- Converting the single bond between C_{1-2} into a double bond: cortisone becomes [[prednisone]], and cortisol becomes [[prednisolone]]
- Introducing fluorine at C_9, prednisolone becomes [[dexamethasone]]
- Introducing a methyl group at C_{16}, prednisolone becomes [[triamcinolone]]
You do not need to know exactly how these modifications occur; this is the concern of pharmaceutical professionals. You only need to know that the more structural modifications introduced, the more complex the synthesis becomes. The synthetic glucocorticoids and mineralocorticoids become less similar to natural mineralocorticoids, so they have less mineralocorticoid effect (water and salt metabolism), while their glucocorticoid effects become stronger (three major metabolic regulations and four major anti-effects), and the half-life is prolonged.
However, no matter how they are modified, these hormones must be metabolized into cortisol in the body to exert their effects.
As for why glucocorticoids can reduce inflammation and the difference between hormone anti-inflammatory effects and NSAIDs anti-inflammatory effects, it is shown in this diagram. If you don’t know about NSAIDs, please see 非甾体抗炎药（解热镇痛药）Nonsteroidal anti-inflammatory drugs （NSAIDs）
If this diagram is difficult to understand, please see 【白学】抗炎选哪个？非甾体抗炎药 VS 糖皮质激素
Clinical Applications
See 糖皮质激素分类记不清？一表掌握 for details