Steroids, also known as glucocorticoids, are among the most widely prescribed drugs in modern medicine. These medications mimic the action of cortisol, the body’s natural “stress hormone” produced by the adrenal cortex. Steroids are vital in treating inflammation, autoimmune conditions, allergies, and adrenal insufficiency.
Commonly used steroid drugs include:
- Prednisone
- Hydrocortisone
- Dexamethasone
- Fludrocortisone
While steroids are powerful lifesaving agents, their long-term use carries significant risks, requiring careful dosing, monitoring, and tapering to avoid adrenal crisis or severe side effects.
Mechanism of Action: How Steroids Work
Steroids exert their action by binding to glucocorticoid receptors in cells, modifying gene expression, and reducing the production of pro-inflammatory cytokines. Their effects include:
- Anti-inflammatory Action: Suppression of immune mediators like prostaglandins and leukotrienes.
- Immunosuppressive Effect: Reducing overactive immune responses in autoimmune diseases.
- Metabolic Effects: Increasing blood sugar, redistributing fat, and affecting protein metabolism.
- Mineralocorticoid Effects (esp. fludrocortisone): Regulating sodium and water balance to maintain blood pressure.
.jpg "Steroids (Prednisone, Hydrocortisone, Dexamethasone) - Uses, Side Effects, 7 S’s Precautions")
Clinical Indications of Steroids
Steroids are prescribed for a wide variety of medical conditions:
Respiratory:
- Chronic Obstructive Pulmonary Disease (COPD)
- Asthma exacerbations
Autoimmune/Inflammatory:
- Rheumatoid Arthritis
- Lupus Erythematosus
- Psoriasis and other skin inflammations
Allergic Reactions:
- Anaphylaxis and severe allergic swelling
Endocrine Disorders:
- Addison’s Disease (adrenal insufficiency)
- Congenital adrenal hyperplasia
Oncology:
- Used in certain cancers to reduce inflammation and nausea
Transplant Medicine:
- To prevent organ rejection
The 7 S’s of Steroid Precautions
A simple mnemonic for remembering steroid precautions is the “7 S’s”. This helps healthcare providers monitor risks and educate patients.
1. S – Swollen
- Weight gain and water retention.
- Report if there is sudden weight gain of >1 lb in 1 day or >2–3 lbs in a few days.
2. S – Sepsis
- Increased risk of infection due to immune suppression.
- Fever + low WBC count must be treated as a medical emergency.
3. S – Sugar Increased
- Steroids cause hyperglycemia, especially in diabetics.
- Monitor blood glucose regularly.
4. S – Skinny
- Loss of muscle and bone mass.
- Increased risk of osteoporosis and fractures.
5. S – Sight
- Risk of cataracts and glaucoma with long-term use.
- Regular eye check-ups are advised.
6. S – Slowly Taper Off
- Never abruptly stop steroids, as it may trigger adrenal crisis.
- Doses should be tapered under medical supervision.
- Dose must be increased during times of physical stress or surgery.
- Prevents adrenal insufficiency.
Side Effects of Steroids
Steroids are often described as a “double-edged sword” due to their numerous side effects.
Short-Term Effects:
- Mood swings, insomnia, irritability
- Increased appetite and fluid retention
- Cushingoid appearance (moon face, buffalo hump, central obesity)
- Hypertension and cardiovascular risks
- Diabetes mellitus due to insulin resistance
- Osteoporosis and fractures
- Cataracts and glaucoma
- Skin changes: thinning, striae, easy bruising
- Adrenal suppression – body loses ability to produce natural cortisol
Contraindications and Cautions
Steroids should be used cautiously in patients with:
- Uncontrolled diabetes
- Active infections
- Hypertension
- Osteoporosis
- Peptic ulcer disease
- Psychiatric conditions (may worsen mood swings/psychosis)
Absolute contraindications are rare, as steroids are often lifesaving, but risks must be weighed carefully.
Crisis Prevention: Addison’s vs. Cushing’s Treatments
- Addison’s Disease: Patients with adrenal insufficiency require lifelong steroid replacement (hydrocortisone or fludrocortisone). Missing doses or stopping abruptly can trigger Addisonian crisis (shock, severe hypotension, hyponatremia).
- Cushing’s Syndrome: Caused by prolonged high steroid levels. Treatment involves gradual tapering, managing symptoms, and addressing underlying causes (e.g., adrenal tumor).
Nursing Management of Steroid Therapy
Nurses play a critical role in ensuring steroid safety:
- Monitor vital signs, blood pressure, and weight gain.
- Educate patients to report signs of infection, vision changes, and unexplained pain.
- Monitor blood glucose levels, especially in diabetics.
- Perform bone density assessments in long-term therapy.
- Ensure gradual tapering under physician supervision.
- Advise patients to take oral steroids with food to prevent gastric irritation.
NCLEX Tips and Commonly Missed Questions
The infographic highlights important NCLEX-style exam points:
- Infections are priority – A patient on steroids with fever and low WBC count must be treated immediately.
- Never stop abruptly – Taper slowly to prevent adrenal crisis.
- Increase dose during stress or surgery – To mimic the natural cortisol surge in the body.
- Monitor sugar and bones – Long-term therapy increases risk of diabetes and osteoporosis.
Frequently Asked Questions (FAQ)
1. Why should steroids not be stopped suddenly?
Stopping abruptly can cause adrenal insufficiency, as the adrenal glands may be suppressed and unable to produce cortisol.
2. How do steroids affect weight?
Steroids cause fluid retention and fat redistribution, leading to weight gain and a cushingoid appearance.
3. Can steroids be taken long-term?
They can, but only under strict medical supervision. Long-term risks include osteoporosis, diabetes, infections, and vision problems.
4. What foods should be avoided on steroids?
Patients should limit salty foods (to reduce fluid retention) and sugary foods (to avoid hyperglycemia).
5. Are steroids the same as anabolic steroids used by athletes?
No. Medical glucocorticoids (like prednisone) are different from anabolic steroids (like testosterone derivatives). Glucocorticoids are used for inflammation and adrenal insufficiency, while anabolic steroids enhance muscle growth.
