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Corticosteroids are hormone mediators produced by the cortex of adrenal glands that further categorize into glucocorticoids, mineralocorticoids, and androgenic sex hormones. They are used in a plethora of conditions, commonly called steroid-responsive disorders and dermatoses. Corticosteroids constitute a double-edged sword - significant benefit with a low incidence of adverse effects can be expected if used in proper dosage and for a limited duration; however, wrong dose and/or duration and unmindful withdrawal after prolonged administration can have catastrophic effects. Corticosteroids are used across all medical specialties. This activity reviews the must-know properties of this group of drugs, their broad indications and contraindications, ways of administration, adverse event profile, practical aspects of the pharmacokinetics of different molecules, monitoring essentials, approach to maximize the benefit and minimize adverse effects, and clinically relevant drug-interactions pertinent for all specialists whether used in isolation or administered by an interprofessional team. Objectives: Review the anti-inflammatory, anti-proliferative, and immunosuppressive actions of corticosteroids. Summarize the monitoring required for corticosteroid therapy. Describe the possible adverse effects of corticosteroid therapy. Explain the importance of improving care coordination among the interprofessional team to enhance the delivery of care to patients requiring corticosteroids. Access free multiple choice questions on this topic.

Acute psychosis can develop in patients receiving high-dose glucocorticoids. Immediate cessation of the drug on the appearance of symptoms is the first step. Although many drugs, including antipsychotics, antidepressants, benzodiazepines, and hydrocortisone, have been tried with variable success, currently, there is no consensus on the ideal therapeutic remedy to stop and reverse the corticosteroid-induced neuropsychiatric adverse effects in adults or children. Their specific adverse effects further limit the use of the medications mentioned above.[24][25] The outcome of limited interventional trials has shown decreased corticosteroid-induced neuropsychiatric symptoms with chlorpromazine and lorazepam, albeit at the cost of drowsiness, orthostatic hypotension, and paradoxical agitation.[31] Physiologic doses of hydrocortisone have shown to improve mild to moderate psychosocial disturbances and insomnia experienced by children who developed severe behavioral problems with dexamethasone-based treatment regime administered to treat ALL.[32] Recently, oral potassium chloride (KCl) administered at a median dose of 0.5 mEq/kg/ day in two divided doses per day reportedly was to be moderately effective in reducing corticosteroid-induced psychiatric events in the majority of children with ALL. No adverse effects were found with oral KCl supplementation.[33]

Glucocorticoids are widely used to manage many acute and chronic inflammatory disorders. The adverse effects of glucocorticoids are extensive and can involve many organ systems. While short-term use of corticosteroids is associated with mild side effects, long-term use can result in several severe adverse effects, some of which are irreversible. This is why an interprofessional team approach to corticosteroid therapy and subsequent monitoring is necessary. Clinicians shall consider adverse effects and patients' underlying comorbidities before prescribing glucocorticoids and use glucocorticoids judiciously. The clinician should use the lowest possible dose for the shortest possible. Patient education is vital in recognizing the adverse effects early. Children are particularly vulnerable to the side effects of corticosteroids, and parents need to understand the benefits and adverse effects of glucocorticoids. Pharmacists shall alert physicians about possible drug interactions, check dosing and duration, and answer patient questions. The nursing team can play a crucial role in communication with the patient, early detection of adverse effects, and regular monitoring. Close communication with other health professionals is necessary to ensure that the patient is not left unmonitored.[34] This kind of interprofessional team methodology to corticosteroid therapy will yield improved patient results while mitigating the numerous and potentially serious adverse effects of such therapy, especially when these agents are used long term. [Level 5]