Corticosteroids

Question 1

Gradual withdrawal required if > _____mg predinisolone equivalent is given for more than 1 week

Answer 1

> 40 mg

Question 2

True or false: steroids should be gradually withdrawn if treatment exceeds 3 weeks

Answer 2

TRUE

Question 3

Which type of corticosteroid causes diabetes as a side effect (mineralocorticoids or glucocorticoids)

Answer 3

Glucocorticoids

Question 4

True or false: psychiatric reactions may occur with corticosteroid use

Answer 4

TRUE
More likely with glucocorticoids

Includes suicidal thoughts, insomnia and psychosis

Question 5

Mineralocorticoid side effects (5 points)

Answer 5

Hypertension
Sodium retention 
Water retention 
Potassium loss 
Calcium loss

Question 6

Betamethasone is a _____ potency glucocorticoid

Answer 6

HIGH potency

Question 7

True or false: Dexamethasone is a potent mineralocorticoid

Answer 7

FALSE - Dexamethasone is a high potency glucocorticoid

Question 8

True or false: corticosteroids are associated with fractures

Answer 8

TRUE

Osteoporosis can be due to glucocorticoid use = increased risk of fragility fractures

Question 9

______ is the only naturally secreted mineralocorticoid

Answer 9

Aldosterone

Question 10

Which drug is used for:

A) mineralocorticoid replacement
B) glucocorticoid replacement

Answer 10

A) Fludrocortisone

B) Hydrocortisone

Note: hydrocortisone does have mineralocorticoid activity but this is not enough for replacement in Addison’s.
May still cause mineralocorticoid side effects in other conditions so don’t use long term

Question 11

True or false:

Regarding corticosteroid replacement in Addison’s disease, the larger dose of hydrocortisone is taken in the evening

Answer 11

FALSE

The larger dose is taken in the morning with a smaller dose at night to mimic the diurnal rhythm of cortisol secretion

Question 12

Monitor _____ and _____ in children receiving corticosteroid treatment (annually)

Answer 12

Height and Weight

Corticosteroids may cause growth retardation

Question 13

Which corticosteroid is used to treat croup

Answer 13

Dexamethasone

Question 14

______ can be used to treat postural hypotension

Answer 14

Fludrocortisone

Question 15

Should both glucocorticoids and mineralocorticoids be given in hypopituitarism?

Answer 15

No

As aldosterone production is also regulated by RAAS (not just the pituitary) there is no deficiency of mineralocorticoids in hypopituitarism

Question 16

Most potent glucocorticoids? (2 points)

Answer 16

Betamethasone and Dexamethasone

Question 17

Abrupt withdrawal of corticosteroids after prolonged therapy may lead to acute ____________

Answer 17

Adrenal insufficiency

May also need to hypotension and in some cases, death

Question 18

True or false: steroids do not need to be gradually withdrawn in those who had repeated doses only in the evening

Answer 18

FALSE

This is one of the criteria for a slow withdrawal

Question 19

A red, puffy, rounded face or a ‘buffalo hump’ are signs of _________

Answer 19

Cushing’s syndrome

Question 20

What are some of the signs of adrenal crisis

Answer 20

Headache.
Fatigue.
Nausea and Vomiting.
Low blood pressure.
Dehydration.
Rapid, shallow breathing. 
Pale, sweaty and clammy skin

Question 21

What are the 5 criteria that would require gradual withdrawal of corticosteroid treatment ?
(To prevent adrenal crisis)

Answer 21

1. > 40mg prednisolone equivalent for at least 1 week
2. > 3 weeks steroid treatment
3. Repeated doses in the evening
4. Repeated courses (especially if > 3 weeks in length)
5. Short course of steroids taken within a year of stopping long term therapy