Corticosteroids

Question 1

What are corticosteroids?

Answer 1

Drugs that augment or replace endogenous glucocorticoid and/or mineralocorticoid activity.

Question 2

What routes can corticosteroids be given by?

Answer 2

Oral, intravenous, topical, inhaled, ophthalmic, and intra-articular.

Question 3

Which steroid has minimal glucocorticoid and very high mineralocorticoid activity?

Answer 3

Fludrocortisone.

Question 4

Which steroid has both glucocorticoid and high mineralocorticoid activity?

Answer 4

Hydrocortisone.

Question 5

Which steroid has predominant glucocorticoid and low mineralocorticoid activity?

Answer 5

Prednisolone.

Question 6

Which steroids have very high glucocorticoid and minimal mineralocorticoid activity?

Answer 6

Dexamethasone and betamethasone.

Question 7

Which corticosteroid is used primarily for mineralocorticoid replacement?

Answer 7

Fludrocortisone.

Question 8

Which corticosteroid is most similar to endogenous cortisol?

Answer 8

Hydrocortisone.

Question 9

What limits the long-term use of corticosteroids?

Answer 9

Their extensive side-effect profile.

Question 10

When are corticosteroid side effects most likely to occur?

Answer 10

With systemic and prolonged therapy.

Question 11

What endocrine side effects are caused by glucocorticoids?

Answer 11

Impaired glucose regulation, increased appetite, weight gain, hirsutism, hyperlipidaemia.

Question 12

What Cushingoid features are associated with glucocorticoid excess?

Answer 12

Moon face, buffalo hump, striae.

Question 13

What musculoskeletal complications are caused by glucocorticoids?

Answer 13

Osteoporosis, proximal myopathy, avascular necrosis of the femoral head.

Question 14

Which bone complication is particularly high-yield for exams?

Answer 14

Avascular necrosis of the femoral head.

Question 15

How do glucocorticoids affect the immune system?

Answer 15

They cause immunosuppression.

Question 16

What infections are patients on steroids particularly at risk of?

Answer 16

Severe infections and reactivation of tuberculosis.

Question 17

What psychiatric side effects are associated with corticosteroids?

Answer 17

Insomnia, mania, depression, psychosis.

Question 18

What gastrointestinal complications can corticosteroids cause?

Answer 18

Peptic ulceration and acute pancreatitis.

Question 19

What ophthalmic side effects are linked to corticosteroids?

Answer 19

Glaucoma and cataracts.

Question 20

What effects do corticosteroids have in children?

Answer 20

Suppression of growth.

Question 21

What neurological effects can occur with corticosteroids?

Answer 21

Intracranial hypertension.

Question 22

What haematological change is seen with corticosteroid use?

Answer 22

Neutrophilia.

Question 23

What are the main mineralocorticoid side effects of corticosteroids?

Answer 23

Fluid retention and hypertension.

Question 24

What should be done to steroid doses during intercurrent illness?

Answer 24

They should be doubled.

Question 25

Why must long-term corticosteroids not be stopped abruptly?

Answer 25

They suppress endogenous steroid production and sudden withdrawal can cause an Addisonian crisis.

Question 26

When does the BNF recommend gradual withdrawal of systemic corticosteroids?

Answer 26

If more than 40 mg prednisolone daily for over 1 week, treatment longer than 3 weeks, or recent repeated courses.