Steroids

Question 1

State whether the following hormones are secreted from the adrenal cortex or adrenal medulla?

Answer 1

Adrenaline M Glucocorticoids C Noradrenaline M Gonadocorticoids C Mineralocorticoids C

Question 2

State whether the following exert predominantly glucocorticoid activity (G) or mineralocorticoid activity (M)?

Answer 2

Dexamethasone (G) Fludrocortisone (M) Betamethasone (G) Triamcinolone (G) Aldosterone (M) Hydrocortisone (G) Prednisone (G).

Question 3

Steroids have many uses, one being anti-inflammatory. In what situation would an individual require steroids to be prescribed, rather than NSAID’s?

Answer 3

When NSAID’s are ineffectual or there are contraindications for use.

Question 4

The following statements are true of steroids!

Answer 4

1) Steroids act on their target cells by promoting or inhibiting the synthesis of mRNA!
2) Steroids increase the synthesis of lipocortin!
3) Lipocortin inhibits phospholipase A2!
4) Prednisolone has an action which lasts longer than hydrocortisone!
5) Steroids are metabolised in the liver, and excreted in urine!

Question 5

Place prednisone, hydrocortisone and betamethasone in order from the ‘shortest acting’ to the ‘longest acting’?

Answer 5

Hydrocortisone, Prednisone, Betamethasone.

Question 6

Explain the mechanism by which glucocorticoids (which are potent inhibitors of inflammatory processes and are widely used in the treatment of asthma) have the potential to cause hyperglycaemia (excessive glucose circulating in blood plasma)?

Answer 6

Glucocorticoids have the potential to cause hyperglycaemia via

1) Increasing the generation of glucose,
2) Increasing the breakdown of glycogen,
3) Increasing protein catabolism.

Question 7

Explain the mechanism by which glucocorticoids have the potential to change fat distribution in the body?

Answer 7

Glucocorticoids mobilises fat from periphery, deposits it on the trunk!

Question 8

Explain the mechanism by which glucocorticoids have the potential to suppress the immune system?

Answer 8

1) Alter blood cell levels in plasma.
2) Cell mediated immunity depressed.
3) Macrophage function inhibited.
4) Reduced antigen release.
5) Reduced antibody production.

Question 9

Explain the mechanism by which glucocorticoids have the potential to suppress the inflammatory response?

Answer 9

1) Inhibits lymphocyte proliferation and transport, (thus reduces level of
circulating lymphocytes).
2) Inhibits synthesis of inflammatory mediators (leading to a reduction of the levels of prostaglandins and leukotrienes).
3) Inhibits mast cell degranulation (thus decreases histamine and capillary permeability and exudation).

Question 10

Explain the mechanism by which glucocorticoids have the potential to increase the body’s resistance to stress?

Answer 10

Helps to maintain homeostasis, increases blood glucose.

Question 11

Explain the mechanism by which glucocorticoids have the potential to cause or exacerbate osteoporosis?

Answer 11

Increase in osteoclastic activity (breaking down bone) leading to bone resorption, plus a decrease in osteoblastic activity (the building of new bone) leading to decreased bone formation.

Question 12

Explain the mechanism by which glucocorticoids have the potential to cause or exacerbate hypertension?

Answer 12

Glucocorticoids increases fluid reabsorption from kidneys, some vasoconstriction of blood vessels which increases pr

Question 13

Explain the mechanism by which glucocorticoids have the potential to impair wound healing?

Answer 13

Protein catabolism, immune suppressant, anti- inflammatory

Question 14

Explain the mechanism by which glucocorticoids have the potential to cause myopathies?

Answer 14

Protein catabolism

Question 15

Explain the mechanism by which glucocorticoids have the potential to cause growth retardation in children?

Answer 15

Glucocorticoids suppress release of HGH.

Question 16

Explain the mechanism by which glucocorticoids have the potential to increase an individual’s susceptibility to infection?

Answer 16

Glucocorticoids are immune suppressant and anti-inflammatory.

Question 17

The topical use of steroids is common. What are the major side effects with prolonged use of steroids creams for dermatological disorders?

Answer 17

Infection, thinning, bruising.

Question 18

The topical use of steroids is common. What are the major side effects with prolonged use of steroid eye drops?

Answer 18

Viral infection, cataract and glaucoma.

Question 19

The topical use of steroids is common. What are the major side effects with prolonged use of inhalational steroids e.g. for asthma?

Answer 19

Fungal infection and hoarseness.

Question 20

The topical use of steroids is common. What are the major side effects with prolonged use of intra-articular injections for arthritides?

Answer 20

Infection and necrosis.

Question 21

Match generic name with commonly used trade names?

Answer 21

GENERIC NAME / TRADE NAME
Hydrocortisone = Hysone + Sigmacort.
Prednisone = Panafcort + Sone.
Prednisolone = Solone + Panafcortelone.
Triamcinolone = Aristocort + Kenacort.
Betametasone and Dexamethasone = Celestone + Betnovate.
Mometasone = Nasonex.
Fluticasone = Flixotide.
Budesonide = Rhinocort.

Question 22

The following statements are true of steroid drugs.

Answer 22

1) Hydrocortisone has potent salt and fluid retaining effects.
2) Useful inhalational drugs for asthma include triamcinolone and budesonide.
3) Prednisone and prednisolone are usually taken orally, and are known as ‘intermediate
acting’.
4) Betamethasone and Dexamethasone can be administered orally, topically and intra-
muscularly.
5) Topical application of hydrocortisone is useful for eczema

Question 23

Why do patients who take oral steroids need to be warned against taking aspirin concurrently?

Answer 23

It increases the risk of peptic ulceration.

Question 24

Why do patients who take oral steroids need to be warned against using antacids concurrently?

Answer 24

It will reduce the absorption of the drug.

Question 25

Why do diabetics need to be particularly vigilant when they use steroids?

Answer 25

Risk of fungal infections, will delay wound healing, + it will increase blood glucose.