Corticosteroids Question And Answers

Cortico Steroids Important Notes

1. Classification of corticosteroids

• Based on half-life
  • Short-acting – cortisone, hydrocortisone
  • Intermediate-acting – prednisolone, triamcinolone
  • Long-acting – dexamethasone, betamethasone
• Based on action
  • Primary glucocorticoid only – hydrocortisone, prednisolone, methylprednisolone, triamcinolone, dexamethasone, betamethasone
  • Mineralocorticoids only – desocxycorticosterone acetate
  • Primary mineralocorticoid – fludrocortisone, aldosterone
• Based on route
• Inhalation – beclomethasone, disproportionate, budesonide, flunisolide
• Systemic – hydrocortisone, prednisolone

2. Corticosteroids Actions:

• Anti-inflammatory
• Anti-allergic
• Vasopressor
• Water excretion
• Increase glucose
• Lipolysis

3. Corticosteroids Uses

• Addison’s disease
• Allergic diseases
• Skin diseases
• Autoimmune diseases
• Rheumatoid arthritis
• Rheumatic fever
• Dental uses
  • Desquamtive gingivitis
  • Autoimmune diseases
  • Oral submucous fibrosis

4. Corticosteroids Adverse effects

• Mineralocorticoid
  • Sodium and water retention
  • Hypokalaemia alkalosis
• Glucocorticoids
  • Cushing’s habitus
  • Fragile skin
  • Hyperglycaemia
  • Increased susceptibility to infection
  • Delayed wound healing
  • Peptic ulceration
  • Osteoporosis
  • Growth retardation
  • Psychiatric disturbances
  • HPA axis suppression

Read And Learn More: Pharmacology Question and Answers

5. Corticosteroids Contraindications

• Cushing’s syndrome
• Acute inflammatory diseases

Cortico Steroids Long Essays

Question 1. Classify glucocorticoids. Describe the mechanism of action, adverse effects, and therapeutic uses.
Answer:

1. Short-acting – hydrocortisone.
2. Intermediate-acting – prednisolone, methylprednisolone.
3. Long-acting – dexamethasone, betamethasone.

Mechanism of action:

Glucocorticoids Uses:

1. Replacement therapy.

2. Pharmacotherapy.

• Arthritis
  • Rheumatoid arthritis.
    • Used along with NSAIDS
  • Osteoarthritis.
    • Used as intra-articular injections.
• Rheumatic carditis.
  • Used in severely ill patients with fever.
• Acute gout
• Allergic diseases.
• Bronchial asthma.

• Collagen diseases.
  • Prednisolone was used for 6 weeks,
• Eye diseases.
• Renal diseases.
• Skin diseases.
• Gastrointestinal diseases.
• Liver diseases.
• Hematologic disorders.
• Cerebral edema.
  • Large doses of dexamethasone are used.
• Malignancies
  • Provide rapid symptomatic relief.
• Lung diseases
• Organ transplantation.
• Other uses:
  • Sarcoidosis.
  • Pneumocystis jirovici.
  • Hemolytic anemia.

Glucocorticoids Adverse Effects:

• Cushing’s syndrome.
• Hyperglycaemia.
• Increased susceptibility to infections.
• Osteoporosis.
• Avascular necrosis.
• Peptic ulceration.
• Mental disturbances.
• Cataract, glaucoma.
• Delayed wound healing.
• H PA axis suppression.
• Mineralocorticoid effects:
  • Salt and water retention
  • Edema
  • Weight gain
  • Hypokalemia
  • Hypertension.

Question 2. Enumerate synthetic corticosteroids. Mention their pharmacology, uses, and toxicity.
Answer:

Synthetic corticosteroids:

• They are more selective corticosteroids
• They are more potent than, natural ones.
• They do not have mineralocorticoid action
• They include.

1. Synthetic corticosteroids Prednisolone.

• Intermediate acting.
• Used for allergic, inflammatory, autoimmune diseases and malignancies.
• High doses cause fluid retention.
• Causes less HPA axis suppression.

2. Synthetic corticosteroids Methylprednisolone.

• More potent and more selective.
• 4 – 32 mg/day is given orally.
• Used in rheumatoid arthritis, renal transplant, and pemphigus.

3. Synthetic corticosteroids Triamcinolone.

• Highly selective
• Used 4 – 32 mg/day orally, 5 – 40 mg IM, as intra- articular injections as well as topically.

4. Synthetic corticosteroids Dexamethasone.

• Long action
• Used in
  • Inflammatory conditions,
  • Allergic conditions.
  • Shock.
  • Cerebral edema.
• Adverse effects
  • Marked HPA suppression
  • Less fluid retention and hypertension.

5. Synthetic corticosteroids Betamethasone.

• Similar to dexamethasone.
• Uses:
  • Cerebral edema
  • Use where fluid retention is required.

6. Synthetic corticosteroids Deflazacort

• Highly selective.
• Less potent
• Causes fewer adverse effects

Question 3. Name adrenocorticosterolds.
Answer:

Adrenocorticosteroids:

•They are compounds created by the adrenal cortex that have distant metabolic effects.

•They include.

1. Glucocorticoids
2. Mineralocorticoids and
3. Androgens.

Cortico Steroids Short Essays

Question 1. Difference between natural and synthetic glucocorticoids.
Answer:

Question 2. Adverse effects of glucocorticoids.
(or)
Adverse effects of prednisolone.
Answer:

1. Cushing’s syndrome.
   • Characterized by a moon face, supraclavicular or hump, obesity of trunk, muscle wasting, thin limbs and skin, and easy brushing.
   • Cutaneous atrophy, purple striae, acne.
2. Hyperglycaemia, precipitation of diabetes mellitus.
3. Increased susceptibility to infections. Opportunistic infections, due to immune suppression.
4. Muscle weakness, myopathy occasionally.
5. Osteoporosis, especially of vertebrae.
6. Peptic ulceration on prolonged use.
7. Avascular necrosis.
8. Growth retardation in children due to prolonged use.
9. Mental disturbances.
   • With high doses of steroids.
10. Delayed wound healing.
11. Cataract and glaucoma – when used as eye drops.
12. Foetal abnormalities.
    • When administered during pregnancy, it causes cleft palate and other defects.
13. HPA (Hypothalamo-pituitary adrenal) axis suppression.
    • It is withdrawal syndrome.
    • Causes reactivation of disease.

Question 3. Explain why glucocorticoid therapy should not be stopped abruptly.
(or)
Abrupt cessation of prolonged administration of glucocorticoids is hazardous. Explain.
Answer:

After prolonged administration of glucocorticoids, it should be tapered before withdrawal.

• Sudden cessation may cause suppression of the hypothalamic-pituitary-adrenal axis suppression.
• This leads to.
  • Precipitation of underlying disease.
  • Reactivation of disease.
  • Withdrawal symptoms like fever, myalgia, arthralgia, and malaise.
  • Such patients may be subjected to stress and can go to acute adrenal insufficiency.
  • Characterized by anorexia, nausea, vomiting, abdominal pain, hypotension, dehydration, and hyper-kalaemia.
• Any patient who has received more than 20 – 25 mg per day of hydrocortisone, needs tapering of the dose.
• If a patient has received long-term steroids within the previous six months, hydrocortisone is administered pro-prophylactically in such patients.

Cortico Steroids Short Question And Answer

Question 1. Adverse effects of glucocorticoids.
Answer:

glucocorticoids Adverse Effects:

• Cushing’s syndrome.
• Hyperglycaemia.
• Increased susceptibility to infections.
• Osteoporosis.
• Avascular necrosis.
• Peptic ulceration.
• Mental disturbances.
• Cataract, glaucoma.
• Delayed wound healing.
• H PA axis suppression.
• Mineralocorticoid effects:
  • Salt and water retention
  • Edema
  • Weight gain
  • Hypokalemia
  • Hypertension.

Question 2. Prednisolone.
Answer:

Prednisolone is a synthetic glucocorticoid.

• It is more selective and four times more potent than hydrocortisone.

Prednisolone Uses:

• Allergic reactions.
• Inflammatory conditions.
• Autoimmune diseases.
• Malignancies.

Prednisolone Adverse Effects:

• Fluid retention in high doses
• Less HPA axis suppression.

Question 3. Betamethasone.
Answer:

Betamethasone is long acting glucocorticoid.

• It is potent and highly selective.

Betamethasone Uses:

• Cerebral edema.
• Inflammatory conditions.
• Allergic reactions.
• Shock.

Betamethasone Adverse Effects:

• Marked HPA axis suppression.
• But does not cause fluid retention.

Question 4. Hydrocortisone.
Answer:

Hydrocortisone is a short-acting corticosteroid.

• It may be natural or synthetic.
• It has mineralocorticoid activity.
• The normal rate of secretion – 10 mg/day.

Hydrocortisone Uses:

• Anti-inflammatory.
• Allergic reactions.

Hydrocortisone Disadvantages:

• Delays wound healing.

Question 5. Uses of glucocorticoids.
Answer:

glucocorticoids Use:

1. Endocrinal uses.

• Replacement therapy.
  • Acute adrenal insufficiency.
  • Chronic adrenal insufficiency.
  • Congenital adrenal hyperplasia.

2. Non-endocrinal uses.

• Arthritis – rheumatoid arthritis, osteoarthritis, rheumatic fever, acute gout
• Allergic reactions.
• Bronchial asthma.
• Collagen diseases
• Eye diseases.
• Skin diseases.
• Renal diseases
• Liver diseases
• Lung diseases
• Gastrointestinal diseases.
• Cerebral edema.
• Organ transplantation.
• Malignancies
• Hematological disorders.
• Other – sarcoidosis, pneumocystis jiroveci, hemolytic anemia.

Question 6. Adrenocorticotropic hormone (ACTH).
Answer:

ACTH is a 39 amino acid single-chain peptide.

• It promotes steroidogenesis in the adrenal cortex by stimulating cAMP formation.
• Absence of ACTH results in adrenal atrophy.
• Hypothalamus regulates ACTH release from the pituitary.
• Excess production of ACTH causes Cushing’s syndrome.

ACTH Uses:

• Used primarily for the diagnosis of disorders of the pituitary-adrenal axis.
• When used IV, it increases plasma cortisol if the adrenals are functional.
• It serves as a diagnostic tool for differentiating between primary and secondary adrenal insufficiency.

Question 7. Difference between hydrocortisone and dexamethasone.
Answer:

Question 8. Name four glucocorticoids.
Answer:

1. Short-acting – cortisone, hydrocortisone.
2. Intermediate acting.
   • Prednisolone, methylprednisolone.
3. Long-acting.
   • Dexamethasone, betamethasone.