Corticosteroids (systemic)
also: prednisolone · hydrocortisone · dexamethasone · glucocorticoid · steroids
Overview
Cross-cutting anti-inflammatory/immunosuppressant used across nearly every specialty. The adverse-effect profile, the never-stop-abruptly rule and sick-day rules are core exam content.
Mechanism
Bind cytoplasmic glucocorticoid receptors → modulate gene transcription: ↓pro-inflammatory cytokines/COX-2/phospholipase A₂, suppressed immune-cell function (anti-inflammatory + immunosuppressive). Mineralocorticoid activity (esp. hydrocortisone) → Na⁺/water retention, K⁺ loss.
Indications
- Inflammatory/autoimmune disease, asthma/COPD exacerbations, allergy/anaphylaxis (adjunct)
- Replacement in adrenal insufficiency (hydrocortisone)
- Croup, cerebral oedema, antenatal lung maturation (dexamethasone) — cross-references
The agents
OD morning
Workhorse oral steroid.
IV/oral
Acute (anaphylaxis, Addisonian crisis) + replacement.
Croup, cerebral oedema, antenatal, antiemetic.
Adverse effects
Bone protection if long-term.
Never stop long-term steroids suddenly — taper; sick-day rules (double dose when ill).
Cautions & contraindications
Adrenal crisis.
Interactions
- NSAIDs → GI ulcer
- ↑glucose (antagonise antidiabetics)
- CYP inducers reduce efficacy
- Live vaccines
Monitoring & kinetics
Glucose, BP, weight; bone protection + PPI if long-term; growth in children,Steroid treatment card for >3 weeks
Oral/IV/IM/topical/inhaled. Give oral once daily in the morning (mimics circadian cortisol).
Source: BNF — Corticosteroids · NICE CKS — Corticosteroids