[2T2S] [PHARMA] [4] Steroids

What category of drugs is classified as being purely anti-inflammatory?

Steroids

Which class of medication is used purely for pain relief?

Opioids

What type of drugs provide both pain relief and anti-inflammatory effects?

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

What are the two branches of steroids?

Sex steroids, glucocorticosteroids

What are the five components of sex steroids?

Estrogen, Progesterone, Androgen (Testosterone), Sexual Characteristics, Reproductive functions

True or False: Estrogen is a sex steroid found only in females.

FALSE

Which sex steroid is considered the most common and abundant in the human body?

a) Progesterone
b) Estrogen
c) Testosterone
d) Cortisol

c) Testosterone

In the male reproductive system, where are sperm cells produced?

Testicles

In the female reproductive system, where are egg cells produced?

Ovaries

True or False: Testosterone is prominent only in males.

FALSE

What are the different sexual characteristics that develop among males?

voice in puberty, facial and body hair, muscle bulk, penis, mature sperm cell, adam’s apple

What are the different sexual characteristics that develop among females?

softer facial features, wider hips, clitoris, menstruation

Steroids are also known as?

Androgenic Anabolic Steroids (AAS)

Which property of Androgenic Anabolic Steroids (AAS) is specifically responsible for enhancing male characteristics?
a) Anabolic
b) Ergogenic
c) Androgenic
d) Catabolic

c) Androgenic

Which property of Androgenic Anabolic Steroids (AAS) is specifically responsible for increasing muscle mass?
a) Anabolic
b) Ergogenic
c) Androgenic
d) Catabolic

a) Anabolic

Which property of Androgenic Anabolic Steroids (AAS) is specifically responsible for enhancing performance in sport?
a) Anabolic
b) Ergogenic
c) Androgenic
d) Catabolic

b) Ergogenic

Which international agency is responsible for releasing what substances are banned every year in professional league sports?

World Anti-Doping Agency (WADA)

What other anabolic agents are prohibited at all times by the WADA?

Clenbuterol, selective androgen receptor modulators, tibolone, zeranol, zilpaterol

What are the effects of AAS in general?

Increase in muscle mass, increase in strength, anti catabolic effects, endpoints (size and strength)

True or False: Intake of AAS can lead to hypertrophy and hypoplasia

FALSE

An increase in strength through steroid use is primarily related to:
a) Decreased calcium sensitivity
b) Enhanced calcium release from the SR 
c) Increased protein breakdown
d) Reduced muscle fiber count

b) Enhanced calcium release from the SR

True or False: Using steroids alone, without training, will effectively enhance your size and strength.

FALSE

True or False: The anti-catabolic effect of steroids means that muscle breakdown is accelerated to make room for new growth.

FALSE

What types of sports would usually make use of steroids?

Gymnasts, boxers, MMA, football, rugby, contact sports

What are the adverse effects of steroids on the cardiovascular system?

Increased LDL, Decreased HDL, Hypertension, Elevated triglycerides, Atherosclerotic heart disease

Which adverse effect of steroids on the cardiovascular system is irreversible?

Atherosclerotic heart disease

What are the adverse effects of steroids on the male reproductive system?

Testicular atrophy, Gynecomastia, Impaired spermatogenesis, Altered libido, Male pattern baldness

Which adverse effect of steroids on the male reproductive system is irreversible?

Male pattern baldness

Which adverse effect of steroids on the male reproductive system is possibly reversible?

Gynecomastia

What are the adverse effects of steroids on the female reproductive system?

Menstrual dysfunction, Altered libido, Clitoral enlargement, Deepening of the voice, Male pattern baldness

Which adverse effect of steroids on the female reproductive system is irreversible?

Clitoral enlargement, deepening of the voice, male pattern baldness

What are the adverse effects of steroids on the hepatic system?

Elevated liver enzymes, Jaundice, Hepatic tumors, Peliosis hepatis

Which adverse effect of steroids on the hepatic system is irreversible?

Hepatic tumors, Peliosis hepatis

What are the adverse effects of steroids on the endocrine system?

Altered glucose tolerance, Decreased FSH, LH, Acne

Which adverse effect of steroids on the endocrine system is irreversible?

N/A

What are the adverse effects of steroids on the musculoskeletal system?

Premature epiphyseal closure, Tendon degeneration

Which adverse effect of steroids on the musculoskeletal system is irreversible?

Premature epiphyseal closure

What are the adverse effects of steroids on the central nervous system?

Mood swings, Violent behavior, Depression, Psychosis

Which adverse effect of steroids on the central nervous system is irreversible?

N/A

Which subset of corticosteroids is primarily focused on for its role in addressing inflammation, metabolism, and immune function?

Glucocorticoids

Besides glucocorticoids, what is the other primary category of corticosteroids mentioned in the sources that controls fluids and electrolytes?

Mineralcorticoids

True or False: The production of corticosteroids is regulated by a negative feedback mechanism.

TRUE

What hormone is released by the hypothalamus to initiate the HPA axis (Hypothalamo-Pituitary Axis)?

CRH (Corticotropin Releasing Hormone)

The pathway for corticosteroid production begins with the release of CRH from which structure? 
a) Anterior pituitary 
b) Adrenal cortex 
c) Hypothalamus 
d) Ovaries

c) Hypothalamus

Which of the following is stimulated by ACTH to produce corticosteroids? 
a) Hypothalamus 
b) Anterior pituitary 
c) Adrenal cortex 
d) Testicles

c) Adrenal cortex

Which hormone is released by the anterior pituitary gland to stimulate the adrenal cortex? 
a) CRH 
b) Cortisol 
c) ACTH 
d) Estrogen

c) ACTH

What is the main corticosteroid in the body that controls immune processes?

Cortisol

What are the physiologic effects of cortisol to the body?

Increase in blood glucose and liver glycogen, Anti-inflammatory, Immunosuppression, Enhances sodium and water reabsorption, Behavioral and mood changes

How does cortisol affect glucose in tissues other than the liver?
a) Increases storage in cells
b) Decreases uptake and utilization
c) Stimulates immediate sugar breakdown
d) Promotes insulin sensitivity

b) Decreases uptake and utilization

True or False: Steroids are considered more effective for inflammation than NSAIDs because they inhibit both cyclooxygenase and lipooxygenase.

TRUE

Which of the following cell types decreases in the blood due to the immunosuppressive effects of steroids?
a) RBCs
b) Neutrophils
c) Platelets
d) Lymphocytes

d) Lymphocytes

True or False: Cortisol prevents edema and swelling by causing vasodilation in the affected area.

FALSE

Cortisol increases lipolysis (fat breakdown) in most tissues but increases fat deposition in which specific area?
a) Face and neck only
b) Abdominal adipose tissue
c) Lower extremities
d) Hands and feet

b) Abdominal adipose tissue

True or False: One anti-inflammatory mechanism of steroids is the stabilization of lysosomes so they do not initiate the inflammatory process.

TRUE

Steroids can cause a patient to swell because they enhance the reabsorption of which two substances?

Sodium and water

True or False: While steroids decrease certain white blood cells, they actually increase the count of RBCs, Neutrophils, and Platelets.

TRUE

What term is used to describe the extreme behavioral and mood changes, specifically violent behavior, associated with steroid use?

Steroid rage

Unlike steroids, NSAIDs are purely anti-inflammatory and only inhibit which specific enzyme?
a) Lipooxygenase
b) Cyclooxygenase
c) Eicosanoid
d) Chemotaxin

b) Cyclooxygenase

Which administration route is typically used for simple mosquito bites, acne, or skin allergies?

Topical

What are the eye drops mentioned specifically for treating conjunctivitis when there is excessive inflammation and redness?

Pred forte

True or False: Topical steroids can be given even if there is an ongoing infection

FALSE

A patient is given inhalational steroids because their asthma is not responding to which type of medication?
a) Antibiotics
b) Bronchodilators
c) Antihistamines
d) Opioids

b) Bronchodilators

Three examples of oral steroids

Prednisone, Dexamethasone, Methylprednisolone

Oral steroids are indicated for any anti-inflammatory management, which includes?

Severe OA, Chronic diseases not responsive to topical like eczema and psoriasis, Cancer

True or False: A patient may shift from topical steroids to oral steroids if the chronic disease is not responsive to the topical treatment.

TRUE

Which administration route is preferred when a patient is admitted to the hospital and cannot tolerate oral routes?

Intravenous (IV)

Between IV and IM injections, which is generally preferred for having less incidence?

IV

True or False: Steroid injections in joints can be performed frequently without risk of damage to the surrounding structures.

FALSE

Which of the following is a shoulder condition mentioned as an indication for joint steroid injections? 
a) Chronic OA
b) Torn ligaments
c) Adhesive capsulitis
d) Back pain

c) Adhesive capsulitis

In which specific space is a steroid injected to treat chronic low back pain?

Epidural

True or False: Epidural injections for the lumbar region are performed under the guidance of an X-ray or image intensifier.

TRUE

True or False: Both methylprednisolone and dexamethasone can be administered either orally or intravenously.

TRUE

"What are the symptoms associated with Cushing's syndrome?"

Centripetal obesity, Moon face, Buffalo hump, Hyperglycemia, Hypertension

True or False: Long-term use of topical steroids or eye drops is the primary cause of Cushing’s Syndrome.

FALSE

Which physiological mechanism is triggered when high levels of exogenous cortisol signal the hypothalamus and pituitary gland to stop secreting?

Negative feedback mechanism

True or False: When a patient stops taking oral or IV steroids, the HPA axis recovers immediately.

FALSE

"Which route of steroids is most likely to develop Cushing's?"

Oral

Which of the following is a manifestation of adrenocortical suppression?
a) Hypertension
b) Postural hypotension
c) Weight gain
d) Hyperactivity

b) Postural hypotension

What are the manifestations of adrenocortical suppression?

Anorexia, Nausea/vomiting, Weight loss, Headache, Fever, Muscle and joint pains, Postural hypotension, Lethargy

What is the specific practice of gradually reducing a steroid dose to allow the HPA axis to recover?

Dose tapering

"Which catabolic effect is described as being ""very common"" with steroid use?
a) Muscle hyperplasia
b) Osteoporosis
c) Increased bone density
d) Joint lubrication"

b) Osteoporosis

What dangerous musculoskeletal complication involves the collapse of spinal bones due to catabolic effects?

Vertebral compression fractures

True or False: Steroids can cause growth retardation in young patients by causing the early closure of the epiphysis of long bones.

TRUE

Besides steroids, which other drug group is known for causing peptic ulcers? 
a) Opioids
b) NSAIDs
c) Antibiotics
d) Anticonvulsants

b) NSAIDs

What eye condition is defined as an increase in intraocular pressure caused by steroid use?

Glaucoma

What eye condition is characterized by the opacity of the lens?

Cataracts

The central effect of chronic steroid use that involves nervousness, mood swings, and psychosis is colloquially known as: 
a) Cushing's mood
b) Steroid rage
c) Adrenal lethargy
d) Catabolic crisis

b) Steroid rage

What are other adverse effects of steroids?

Peptic ulcers, Increased susceptibility to infection, Growth retardation, Glaucoma, cataracts, Nervousness, mood swings, psychosis

What term describes the time required for a drug concentration in the body to be reduced by 50%?

Elimination half life

"What term refers to the duration of the drug's effects, which can persist even after the person has stopped taking the steroid?"

Biologic half life

True or False: The biologic half-life of a steroid is identical to its elimination half-life.

FALSE

What is the biologic half-life range for short-acting steroids?

8-12 hours

What are examples of short acting steroids?

Cortisol (Cortef, hydrocortone), Cortisone (Cortone)

What is the biologic half-life range for intermediate-acting steroids?

12-36 hours

What are examples of intermediate acting steroids?

Prednisone (Decortisyl), Prednisolone (Histacort), 6-Methylprednisolone (Solu Medrol), Triamicinolone (Kenacort, Ledercort)

Which of the following is an example of an intermediate-acting steroid? 
a) Cortisone
b) Dexamethasone
c) Prednisone
d) Betamethasone

c) Prednisone

True or False: Triamcinolone (Kenacort, Ledercort) is classified as an intermediate-acting steroid.

TRUE

What is the biologic half-life range for long-acting steroids?

36-72 hours

What are examples of long acting steroids?

Paramethasone (Haldrone), Betamethasone (Celestamine, Betnovate), Dexamethasone (Oradexone, Decilone, Maxitrol)

True or False: Steroids are categorized into short, intermediate, and long-acting groups according to their biologic half-life.

TRUE