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Corticosteroids are drugs used in the management and treatment of almost all areas of medicine. This activity outlines the indications, action, and contraindications for corticosteroids as a valuable agent in managing numerous disorders. This activity will highlight the mechanism of action, adverse side effects profile, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) of corticosteroid usage. Objectives: Describe the mechanism of action of corticosteroids. Summarize the potential adverse effects associated with corticosteroids. Review the toxicity profile of corticosteroids. Explain some interprofessional team strategies for improving care coordination and communication to advance the management of patients on corticosteroids and improve outcomes. Access free multiple choice questions on this topic.

The toxicity of corticosteroids accounts for one of the most common causes of iatrogenic illness in patients on chronic therapy.  No specific reversal agent exists for corticosteroids. Their effect in excess is manageable by gradual taper and addressing the particular complication (e.g., hyperglycemia, infection, hypertension). If steroid therapy is in place for less than one week, patients can usually stop without tapering. For dosing lasting one to three weeks, tapering should depend on the clinical conditions for which the patient took the medication. Rapid and complete withdrawal can lead to adrenocorticotropic hormone suppression and flare of the underlying disease. Courses over three weeks should have a quick taper to physiologic doses, then slow weaning should follow while evaluating the adrenal function. Long-term, high-dose suppressive therapy can lead to suppression of the hypothalamic-pituitary-adrenal axis for as long as nine to twelve months following withdrawal.[2]

Corticosteroids are widely used medications due to their benefit. However, they have many adverse effects. Their widespread use and many adverse effects place significant importance on their understanding by all healthcare team members. Their effects that are therapeutic in one patient may be detrimental in another. For example, their glucose-raising effect may be helpful in a patient with adrenal insufficiency but harmful in a patient with latent diabetes mellitus.[2] Careful patient monitoring and the use of proper preventive measures can reduce the adverse effects of corticosteroids and allow their maximal benefit. All interprofessional healthcare team members should be ready to educate their patients on corticosteroids and their potential adverse effects, and the modifications that can reduce these harmful effects. This team includes clinicians, mid-level practitioners, nursing staff, and pharmacists, all working collaboratively with open communication to ensure optimal treatment outcomes with minimal adverse events. All patients on any form of chronic systemic corticosteroid therapy should be identified and advised to carry a treatment card or other signifier that they're on steroid therapy. In this era of electronic medical records, a tag may be applied to patients' charts to specifically notify other healthcare team members about the patient corticosteroid use. Many patient deaths and much morbidity are preventable through proper patient education and communication within the interprofessional team. [Level 5]