Which characteristics apply to synthetic corticosteroids?

• A. Antipyretic
• B. Anti-pruritic
• C. Anti-inflammatory
• D. All of the above

Answer: (D)

Synthetic corticosteroids mimic glucocorticoids, producing broad anti-inflammatory, anti-pruritic, and antipyretic effects. Their anti-inflammatory action comes from suppressing inflammatory mediators: they induce proteins that inhibit phospholipase A2, lowering arachidonic acid and downstream prostaglandin and leukotriene production; they also reduce COX-2 expression, decrease vascular permeability, and dampen leukocyte migration and activation. This combination greatly reduces inflammation, swelling, and associated pain. Their anti-pruritic effect follows from the same reduction of inflammatory mediators and itch signaling in the skin, which lowers itch sensations. Fever reduction occurs because cytokines driving the hypothalamic fever response are suppressed and prostaglandin synthesis in the brain is decreased, helping lower body temperature in inflammatory or immune-mediated states. Because all three effects are observed with these drugs, “all of the above” is the best description. Keep in mind that long-term use can cause side effects like immunosuppression, hyperglycemia, GI ulcers, and adrenal suppression.