Corticosteroids - Glucocorticoids

Question 1

There are 3 layers to the adrenal glands:

• zona glomerulus
• zona fasiculata
• zona reticularis

Match the above layers with what they synthesise and release?

• glucocorticoids
• androgens
• mineralcorticoids

Answer 1

• zona glomerulus =
• mineralcorticoids
• zona fasiculata = glucocorticoids
• zona reticularis = androgens

The deeper you get the sweeter it gets

Question 2

Where in the adrenal gland is adrenaline and noradrenaline synthesised and released?

1 - zona glomerulus
2 - zona fasiculata
3 - medula (chromaffin cells)
3 - zona reticularis

Answer 2

3 - medula (chromaffin cells)

Question 3

Steroids are typically cholesterol based, meaning they are lipophilic. This means that are able to diffuse into cells freely. Once they pass into the cell they are able to elicit actions. Organise the following into what happens within the cells?

1 - diffuse into cell membrane due to small size and hydrophobic nature
2 - cell undergoes transcription and protein synthesis
3 - hormone receptor complex enters the nucleus and cytoplasmic receptor aspect of the hormone receptor complex binds to DNA
4 - steroid hormone binds with cytoplasmic receptor forming hormone receptor complex
5 - hormone receptor complex binds to specific parts of DNA and genes can be turned on or off

Answer 3

1 - diffuse into cell membrane due to small size and hydrophobic nature

4 - steroid hormone binds with cytoplasmic receptor forming hormone receptor complex

3 - hormone receptor complex enters the nucleus and cytoplasmic receptor

5 - hormone receptor complex binds to specific parts of DNA and genes can be turned on or off

2 - cell undergoes transcription and protein synthesis

Question 4

How can glucocorticoids be administered?

1 - Oral
2 - IV
3 - IM
4 - Intra-articular
5 - all of the above

Answer 4

5 - all of the above

Question 5

What is the main mechanism of action of glucocorticoids?

1 - inhibition of B cell synthesis
2 - inhibition of COX1 and 2
3 - Inhibition of prostaglandin and leukotriene synthesis
4 - all of the above

Answer 5

4 - all of the above

Reductions in
- macrophage phagocytosis,
- interleukin (IL)-1 secretion
- number of circulating monocytes

Question 6

If a patient has RA and is already on disease-modifying anti-rheumatic drugs (DMARDs), which 2 drugs can be given to help with flare ups?

1 - paracetamol
2 - non-steroidal drugs
3 - aspirin
4 - glucocorticoids

Answer 6

2 - non-steroidal drugs
4 - glucocorticoids

Given for short periods to allow DMARDs to begin working

Question 7

Which of the following is not a GI symptom typically caused by glucocorticoids?

1 - gastritis
2 - phyloric stenosis
3 - peptic ulcer disease
4 - steatohepatitis
5 - visceral perforation

Answer 7

2 - phyloric stenosis

Should be prescribed with a PPI

Question 8

Which of the following is not a bone and muscle symptom typically caused by glucocorticoids?

1 - rhabdomyolysis
2 - osteoporosis
3 - avascular necrosis
4 - myopathy

Answer 8

1 - rhabdomyolysis

Question 9

Patients with long term steroid use may be more likely to develop osteoporosis. Patients at risk of long term steroid use should be prescribed all of the following EXCEPT which one?

1 - Calcium supplementation
2 - vitamin D supplementation
3 - vitamin C supplementation
4 - Bisphosphonates

Answer 9

3 - vitamin C supplementation

This is good for eyes

Question 10

Which 2 of the following metabolic/endocrine symptoms typically caused by glucocorticoids?

1 - hypoglycaemia
2 - hyperglycaemia
3 - HPA adrenal insufficiency
4 - cushing syndrome

Answer 10

2 - hyperglycaemia
3 - HPA adrenal insufficiency

Question 11

Which 2 of the following immune or haematological symptoms typically caused by glucocorticoids?

1 - increased risk of infection
2 - hyperglycaemia
3 - leukocytosis
4 - polycythemia

Answer 11

1 - increased risk of infection

3 - leukocytosis
- over production of WBCs

Question 12

Which of the following are dermatological symptoms typically caused by glucocorticoids?

1 - acne
2 - hirsutism
3 - facial erythema
4 - weight gain
5 - striae
6 - thinning of the skin
7 - all of the above

Answer 12

7 - all of the above

Question 13

Which of the following could be helpful in mitigating the adverse effects of long term glucocorticoid use?

1 - lowest dose possible prescribed
2 - prescribe for the shortest duration
3 - manage pre-existing conditions
4 - monitor patients at risk of adverse events
5 - all of the above

Answer 13

5 - all of the above