AIIMS Raipur - 2017 (…: Among the following, identify the long-term effect of steroid therapy?

AIIMS Raipur - 2017 (Shift-3)

Pharmacology

Easy

Appeared in: AIIMS Raipur - 2017 (Shift-3)

Explanation

Steroid psychosis is a known, though less common, neuropsychiatric complication of prolonged corticosteroid use.
It encompasses a range of symptoms including severe mood swings, anxiety, depression, insomnia, and in some cases, delusions and hallucinations.
This effect is dose-dependent and results from the influence of corticosteroids on the central nervous system.
It is considered a serious adverse effect that requires careful monitoring and management, which may include reducing the steroid dose or initiating psychiatric treatment.

Option A: Corticosteroids are known to cause hyperglycemia (high blood sugar), not hypoglycemia. They increase gluconeogenesis and insulin resistance.
Option B: A more common dermatological side effect of long-term steroid use is hirsutism (excessive growth of fine hair), not hair loss.
Option C: Long-term steroid therapy classically causes weight gain due to increased appetite, fluid retention (edema), and redistribution of fat (e.g., moon facies, buffalo hump).

Visual 1: Infographic: Systemic Side Effects of Corticosteroids. This visual can illustrate the widespread effects of long-term steroid use, including Cushingoid features like moon face, buffalo hump, central obesity, skin thinning, and striae, alongside other effects like osteoporosis and cataracts.
Visual 2: Chart: Comparing Cushing's Syndrome vs. Addison's Disease. A side-by-side comparison can help differentiate the effects of steroid excess (Cushing's) from steroid deficiency (Addison's), reinforcing why symptoms like weight gain occur with therapy while weight loss occurs with deficiency.

Clinical Relevance

Nursing practice connection: Knowing Adverse effects of long-term corticosteroid therapy helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must conduct thorough assessments of patients on long-term steroids, focusing on mental status, mood, weight, blood pressure, and blood glucose levels.
Patient education is critical. The nurse should teach the patient and family to report any unusual mood swings, insomnia, or behavior changes immediately.
What if the patient was on a short, 5-day course of steroids for an acute allergic reaction? In that case, the risk of steroid psychosis would be extremely low. The risk increases significantly with higher doses and prolonged duration of therapy.

How to Approach the Question

First, identify the core subject of the question: the long-term effects of steroid therapy.
Second, analyze each option provided. Use your pharmacological knowledge to evaluate the plausibility of each effect.
Recall the classic side effects associated with corticosteroids, which often mimic Cushing's syndrome.
Eliminate options that are the opposite of known effects. For example, steroids cause hyperglycemia, so 'Hypoglycemia' is incorrect. They cause weight gain, so 'Loss of weight' is incorrect.
Differentiate between common and less common side effects to select the best answer from the remaining options.
Confirm that 'Steroid psychosis' is a documented, albeit serious, psychiatric side effect of corticosteroid use.

Concept Tested & Keywords

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KD Tripathi - Essentials of Medical Pharmacology (6th Edition) p. 365-372