Comprehensive Corticosteroids: Uses, Mechanisms, and Adverse Effects

What are corticosteroids?

Hormones produced by the adrenal cortex, also called glucocorticoids or steroids.

What is the prototype corticosteroid?

Prednisone

What happens when corticosteroid production is too high or too low?

It causes disease.

What are exogenous corticosteroids?

Steroids given as medications from outside the body.

What is the golden rule for using corticosteroids?

Use the smallest effective dose for the shortest effective time.

What are common therapeutic uses of corticosteroids?

Used for allergic disorders, immune overactivity, adrenal dysfunction, and various other conditions.

What is the mechanism of action of corticosteroids?

They bind to glucocorticoid receptors, alter gene transcription, and change protein synthesis.

What is an absolute contraindication for corticosteroid use?

Systemic fungal infection.

What are Cushingoid features associated with corticosteroid use?

Moon face, buffalo hump, fat redistribution, weight gain.

What should patients be taught about corticosteroids?

They control symptoms but do not cure disease, must be taken as prescribed, and should not be stopped abruptly.

What dietary recommendations are made for patients on corticosteroids?

Reduce sodium; increase potassium, calcium, vitamin D, and protein.

What is the risk of long-term high-dose corticosteroid therapy?

It can suppress adrenal gland function leading to adrenal cortical insufficiency.

What are the routes of administration for corticosteroids?

Oral, parenteral (IM, IV), and local (inhaled, topical, intranasal).

What is the importance of dosing schedules in corticosteroid therapy?

To prevent adrenal insufficiency and manage symptoms effectively.

What are the signs of adrenal insufficiency?

Weakness, fainting, anorexia, nausea, vomiting, hypotension, shock.

What should patients do to prevent infections while on corticosteroids?

Avoid sick individuals, wash hands frequently, and report any signs of infection.

What is the effect of corticosteroids on blood glucose levels?

They can cause hyperglycemia and worsen diabetes.

What are some specific clinical uses of corticosteroids?

Used for allergic rhinitis, arthritis, asthma, COPD, inflammatory bowel disease, and cancer.

What is the significance of tapering corticosteroids?

To prevent withdrawal symptoms and adrenal crisis.

What are the CNS effects of corticosteroids?

Headache, vertigo, paresthesia, insomnia, seizures.

What cardiovascular effects can corticosteroids cause?

Hypertension, heart failure, dysrhythmias, thromboembolism.

What skin effects are associated with corticosteroid use?

Thin skin, red skin, striae, delayed wound healing.

What musculoskeletal effects can occur with corticosteroid therapy?

Osteoporosis, fractures, bone loss.

What eye effects can corticosteroids cause?

Cataracts and glaucoma.

What reproductive effects can corticosteroids have?

Amenorrhea and irregular menstrual cycles.

What should patients wear to alert others of their corticosteroid use?

A medical-alert bracelet or tag.

MOA

MOA 1

Binds to receptors Attach to glucocorticoid receptors in target tissues at the cellular level

MOA 2

Alter gene transcription increase or decrease transcription of many genes

MOA 3

Change protein synthesis Altered proteins regulate the body’s physiologic effects

Risk for infection

may lower resistance

Diabetes mellitus

may raise blood glucose

Active infection

may mask signs & symptoms

Frequency of Administration

Acute Therapy, Alternate Day Therapy

Alternate-Day Therapy Definition

Double dose taken every other day

• Allows a rest period from the medication

• Decreases adverse effects

• Anti-inflammatory effects continue

• Used for maintenance therapy
Intermediate-acting glucocorticoids are the drugs of

choice

Acute Therapy Definition

Large, divided doses for ~48–72 hours, then taper the

remaining dose.

Used for:

• Allergic reactions & contact dermatitis

• Exacerbation of a chronic condition

• Surgery

Cushingoid Features

"Moon face" & "buffalo hump" (fat

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Five things to remember

Know the names Look for the -sone and -olone endings (prototype: prednisone).

Lowest, shortest Smallest effective dose for the shortest effective time.

Never stop abruptly Taper doses — abrupt stops risk loss of adrenocortical function.

Spot Cushingoid signs "Moon face" and "buffalo hump" signal excess effect.

Patient safety Wear medical alert ID, avoid infection, adjust the diet.