Paper II — 2024 December (Supplementary) (2019 Scheme) — Q9
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Paper II
2024 December (Supplementary) (2019 Scheme) · 100 marks · 180 min
Question
Enumerate Four glucocorticoids. Explain the measures to minimize hypothalamo pituitary adrenal axis
suppression. Discuss two other adverse drug reactions of glucocorticoid therapy. (2+3+1)
Q96 marksShort Essays
Answer
Four glucocorticoids: Hydrocortisone, Prednisolone, Dexamethasone, Betamethasone.
Measures to minimize HPA axis suppression
Use the lowest effective dose for the shortest duration necessary to control the condition.
Prefer local/topical routes (inhaled, topical, intra-articular) over systemic therapy where the disease permits, minimizing systemic exposure.
Use alternate-day dosing where clinically feasible — giving the full daily dose every other morning allows the HPA axis a recovery interval on the off day.
Gradual tapering rather than abrupt withdrawal after any course longer than 2-3 weeks, allowing the suppressed axis time to recover its own function.
Administer the daily dose in the morning, mimicking the natural circadian cortisol peak and minimizing disruption to the normal diurnal rhythm.
Two other adverse drug reactions
Osteoporosis (increased fracture risk with long-term use) and peptic ulceration (increased risk particularly with concurrent NSAID use).
