Corticosteroid Effects: Therapeutic vs Adverse — The Same Drug, Two Faces
Every therapeutic effect of prednisone has a dark mirror image at higher doses or longer duration. The NCLEX exploits this — the same mechanism that resolves inflammation also causes Cushing's features, hyperglycemia, and adrenal suppression. Confusing desired effects with adverse ones means missing critical teaching or, worse, abruptly stopping the drug.
Comparison
- Anti-inflammatory & immunosuppressive
- Same broad action drives the side effects
- Treats autoimmune, allergic, inflammatory disease
- ★Immunosuppression — ↑ infection, masks fever
- Replaces cortisol in adrenal insufficiency
- ★Abrupt stop → adrenal crisis — must taper
- Short courses limit metabolic impact
- Hyperglycemia, weight gain, moon face, Cushingoid
- Controls inflammatory arthritis flares
- Osteoporosis, fractures, muscle wasting
- Induces remission in IBD flares
- Peptic ulcers, GI bleed — take with food
- Mineralocorticoid support in Addison's
- Na⁺/fluid retention, edema, ↑ BP, ↓ K⁺
- Lowest effective dose, shortest duration
- Taper off; monitor glucose, weight, infection, mood
Therapeutic Effect
- Anti-inflammatory & immunosuppressive
Adverse Effect
- Same broad action drives the side effects
Therapeutic Effect
- Treats autoimmune, allergic, inflammatory disease
Adverse Effect
- ★Immunosuppression — ↑ infection, masks fever
Therapeutic Effect
- Replaces cortisol in adrenal insufficiency
Adverse Effect
- ★Abrupt stop → adrenal crisis — must taper
Therapeutic Effect
- Short courses limit metabolic impact
Adverse Effect
- Hyperglycemia, weight gain, moon face, Cushingoid
Therapeutic Effect
- Controls inflammatory arthritis flares
Adverse Effect
- Osteoporosis, fractures, muscle wasting
Therapeutic Effect
- Induces remission in IBD flares
Adverse Effect
- Peptic ulcers, GI bleed — take with food
Therapeutic Effect
- Mineralocorticoid support in Addison's
Adverse Effect
- Na⁺/fluid retention, edema, ↑ BP, ↓ K⁺
Therapeutic Effect
- Lowest effective dose, shortest duration
Adverse Effect
- Taper off; monitor glucose, weight, infection, mood
★ marks the fact that sets a column apart.
Clinical Pearl
Short-term hero, long-term Cushing's — same drug, same mechanism, different duration. Never stop abruptly.
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