Steroids

Question 1

Do glucocorticoids mimic aldosterone or cortisol?

Answer 1

Cortisol

Question 2

Do mineralocorticoids mimic aldosterone or cortisol?

Answer 2

Aldosterone

Question 3

Name a corticosteroid with minimal glucocorticoid activity but very high mineralocorticoid activity?

Answer 3

Fludrocortisone

Question 4

Name a corticosteroid with some glucocorticoid activity but high mineralocorticoid activity?

Answer 4

Hydrocortisone

Question 5

Name a corticosteroid with predominant glucocorticoid activity and low mineralocorticoid activity

Answer 5

Prednisolone

Question 6

Sick day rules for patients on long term steroids?

Answer 6

Double dose during intercurrent illness.

Question 7

Abrupt withdrawal of steroids (in patients on long-term treatment) may precipitate what?

Answer 7

Addisonian crisis

Question 8

In what circumstances does the BNF suggests a gradual withdrawal of systemic corticosteroids?

Answer 8

1) if the patient has received more than 40mg prednisolone daily for more than one week

2) if the patient has received more than 3 weeks of treatment

3) if the patient has recently received repeated courses

Question 9

What are the 2 main mineralocorticoid side effects of corticosteroids?

Answer 9

1) fluid rentention
2) HTN

As mineralocorticoids mimic aldosterone.

Question 10

What are some glucocorticoid side effects of corticosteroids?

Answer 10

1) Endocrine:
- impaired glucose regulation
- increased appetite/weight gain
- hirsutism
- hyperlipidaemia

2) Cushing’s syndrome:
- moon face
- buffalo hump
- striae

3) MSK:
- osteoporosis
- proximal myopathy
- avascular necrosis of femoral head

4) Immunosuppression:
- increased susceptibility to severe infection
- reactivation of TB

5) Psychiatric:
- insomnia
- mania
- depression
- psychosis

6) GI:
- peptic ulceration
- acute panreatitis

7) Ophthalmic:
- glaucoma
- cataracts

8) Suppression of growth in children

9) Intracranial HTN

10) Neutrophilia

Question 11

What is hirsutism?

Answer 11

Hirsutism is excess hair growth on the body or face.

Question 12

How can the risk of peptic ulcer disease and GI bleeding be reduced in those on long-term steroid treatment?

Answer 12

Prophylaxis with PPIs or H2-receptor antagonists.

Question 13

How can the risk of hyperglycaemia & DM be reduced in those on long-term steroid treatment?

Answer 13

1) Monitor blood glucose levels regularly.

2) Initiate lifestyle modifications such as dietary changes and physical activity promotion.

3) If hyperglycaemia persists despite lifestyle interventions, consider adding oral hypoglycaemic agents or insulin therapy as per standard diabetes management guidelines.

Question 14

How can steroids affect BP?

Answer 14

Can cause HTN

Question 15

How can steroids affect bones?

Answer 15

Can cause osteoporosis

Question 16

What vaccines should be avoided in patients on steroids?

Answer 16

Avoid live vaccines while on immunosuppressive doses of corticosteroids.