Steroids

Long-acting glucocorticoid

Glucocorticoid receptor agonist — anti-inflammatory, antiemetic, prolongs PNB duration.

Intermediate-acting synthetic glucocorticoid

Binds intracellular glucocorticoid receptor → translocation to nucleus → transcriptional regulation of anti-inflammatory genes (lipocortin-1, IL-10) + suppression of pro-inflammatory genes (NF-κB, COX-2). 5× the glucocorticoid potency of hydrocortisone with minimal mineralocorticoid activity.

Short-acting glucocorticoid + mineralocorticoid

Endogenous cortisol equivalent. Binds both glucocorticoid AND mineralocorticoid receptors — 1× glucocorticoid potency (reference standard), substantial mineralocorticoid effect (sodium retention, K⁺ excretion). The replacement steroid for adrenal insufficiency.