Corticosteroids, including cortisone and related glucocorticoids and mineralocorticoids, are essential drugs in pharmacotherapy. B. Pharm students must understand their mechanisms — nuclear glucocorticoid receptor binding, gene regulation, and effects on inflammation, immunity, metabolism, and electrolyte balance. Study pharmacokinetics (activation by 11β-HSD, half-lives), therapeutic uses (asthma, autoimmune disease, adrenal insufficiency), formulations (oral, IV, inhaled, topical) and major adverse effects (HPA axis suppression, osteoporosis, hyperglycemia, infection risk). Knowledge of potency equivalents, drug interactions (CYP3A4), dosing strategies and monitoring improves safe use and counselling. This focused review and practice MCQs emphasize clinical and pharmaceutic concepts for exams and practice. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which two major classes comprise corticosteroids?
- Glucocorticoids and mineralocorticoids
- Synthetic and biological corticosteroids
- Sulfonylureas and biguanides
- Anabolic steroids and progestins
Correct Answer: Glucocorticoids and mineralocorticoids
Q2. Cortisone is converted to active cortisol primarily by which enzyme?
- 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1)
- CYP3A4
- 5α-reductase
- Aldosterone synthase
Correct Answer: 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1)
Q3. The principal mechanism of glucocorticoid action is:
- Binding to cytoplasmic glucocorticoid receptors and modulating gene transcription
- Blocking beta-adrenergic receptors on cell surfaces
- Inhibiting acetylcholinesterase in synapses
- Activating guanylate cyclase to increase cGMP
Correct Answer: Binding to cytoplasmic glucocorticoid receptors and modulating gene transcription
Q4. Which corticosteroid has the highest glucocorticoid potency among the following?
- Dexamethasone
- Hydrocortisone
- Prednisone
- Cortisone
Correct Answer: Dexamethasone
Q5. Which corticosteroid exhibits the greatest mineralocorticoid (salt-retaining) activity?
- Fludrocortisone
- Dexamethasone
- Prednisolone
- Cortisone
Correct Answer: Fludrocortisone
Q6. A common long-term adverse effect of systemic corticosteroid therapy is:
- Osteoporosis
- Renal tubular acidosis
- Hypoglycemia
- Hyperthyroidism
Correct Answer: Osteoporosis
Q7. Abrupt discontinuation of long-term systemic corticosteroids most commonly risks:
- Acute adrenal insufficiency due to HPA axis suppression
- Tardive dyskinesia
- Acute tubular necrosis
- Serotonin syndrome
Correct Answer: Acute adrenal insufficiency due to HPA axis suppression
Q8. Which drug is used to inhibit 11β-hydroxylase and reduce cortisol synthesis in diagnostic/therapeutic settings?
- Metyrapone
- Spironolactone
- Ketorolac
- Furosemide
Correct Answer: Metyrapone
Q9. Which test is commonly used to screen for Cushing’s syndrome?
- Low-dose dexamethasone suppression test
- Serum troponin I
- Oral glucose tolerance test
- Schirmer’s test
Correct Answer: Low-dose dexamethasone suppression test
Q10. Which of the following is approximately equivalent to 5 mg of prednisone?
- Hydrocortisone 20 mg
- Dexamethasone 5 mg
- Prednisone 10 mg
- Cortisone 5 mg
Correct Answer: Hydrocortisone 20 mg
Q11. Which topical corticosteroid is considered low potency and often used for mild dermatitis?
- Hydrocortisone 1%
- Clobetasol propionate 0.05%
- Betamethasone dipropionate 0.05%
- Diflorasone diacetate 0.05%
Correct Answer: Hydrocortisone 1%
Q12. For persistent asthma control, which inhaled corticosteroid is commonly prescribed?
- Beclomethasone
- Montelukast
- Theophylline
- Salbutamol
Correct Answer: Beclomethasone
Q13. Activation of the mineralocorticoid receptor primarily causes:
- Renal sodium retention and potassium excretion
- Increased insulin sensitivity
- Bronchodilation
- Platelet aggregation
Correct Answer: Renal sodium retention and potassium excretion
Q14. Systemic corticosteroids are relatively contraindicated in which condition?
- Untreated systemic fungal infection
- Rheumatoid arthritis
- Severe asthma exacerbation
- Adrenal insufficiency
Correct Answer: Untreated systemic fungal infection
Q15. Which glucocorticoid is often preferred in pregnancy because the placenta inactivates much of it?
- Prednisone (or prednisolone)
- Dexamethasone
- Fludrocortisone
- Betamethasone
Correct Answer: Prednisone (or prednisolone)
Q16. Cushingoid features such as moon face and central obesity are most directly caused by:
- Long-term systemic glucocorticoid therapy
- Hyperaldosteronism due to adrenal adenoma
- Hyperparathyroidism
- Growth hormone deficiency
Correct Answer: Long-term systemic glucocorticoid therapy
Q17. A major anti-inflammatory action of glucocorticoids is mediated by:
- Induction of lipocortin (annexin-1) leading to inhibition of phospholipase A2 and decreased cytokine transcription
- Activation of cyclooxygenase-2 to increase prostaglandins
- Increasing neutrophil chemotaxis to sites of inflammation
- Stimulating IL-2 production to boost T-cell activity
Correct Answer: Induction of lipocortin (annexin-1) leading to inhibition of phospholipase A2 and decreased cytokine transcription
Q18. To minimize HPA axis suppression while treating chronic inflammation, clinicians may use:
- Lowest effective dose and alternate-day therapy when feasible
- High-dose continuous therapy only at night
- Immediate cessation after one week
- Combining with high-dose NSAIDs indefinitely
Correct Answer: Lowest effective dose and alternate-day therapy when feasible
Q19. The corticosteroid of choice for initial treatment of acute adrenal crisis is:
- Intravenous hydrocortisone
- Oral dexamethasone
- Topical betamethasone
- Inhaled fluticasone
Correct Answer: Intravenous hydrocortisone
Q20. Long-term systemic corticosteroid therapy can cause which ocular adverse effect?
- Raised intraocular pressure leading to glaucoma and cataracts
- Optic neuritis with demyelination
- Acute conjunctival hemorrhage
- Retinal detachment
Correct Answer: Raised intraocular pressure leading to glaucoma and cataracts
Q21. Which drug interaction increases systemic corticosteroid exposure by inhibiting CYP3A4?
- Ketoconazole
- Rifampicin
- Carbamazepine
- St. John’s Wort
Correct Answer: Ketoconazole
Q22. Metabolic side effects commonly seen with corticosteroids include:
- Hyperglycemia and insulin resistance
- Hypoglycemia and increased insulin sensitivity
- Hypokalemia without sodium changes
- Marked hypolipidemia
Correct Answer: Hyperglycemia and insulin resistance
Q23. The receptor for glucocorticoids belongs to which class of receptors?
- Nuclear steroid receptor that functions as a transcription factor
- G protein–coupled receptor on the cell membrane
- Ligand-gated ion channel
- Receptor tyrosine kinase
Correct Answer: Nuclear steroid receptor that functions as a transcription factor
Q24. Which corticosteroid is classified as long-acting with minimal mineralocorticoid activity?
- Dexamethasone
- Hydrocortisone
- Cortisone
- Fludrocortisone
Correct Answer: Dexamethasone
Q25. Symptoms of adrenal insufficiency after abrupt steroid withdrawal commonly include:
- Fatigue, weakness, hypotension and anorexia
- Hypertension, weight gain and moon face
- Palpitations and hyperreflexia
- Polycythemia and increased appetite
Correct Answer: Fatigue, weakness, hypotension and anorexia
Q26. Activation of cortisone to cortisol occurs mainly in which tissues?
- Liver and adipose tissue via 11β-HSD1
- Kidney via 11β-HSD2 only
- Pancreas via acetyltransferase
- Bone marrow via CYP17
Correct Answer: Liver and adipose tissue via 11β-HSD1
Q27. Which corticosteroid has minimal mineralocorticoid effect and is therefore suitable when salt retention is undesirable?
- Dexamethasone
- Fludrocortisone
- Aldosterone
- Cortisone acetate
Correct Answer: Dexamethasone
Q28. In oncology supportive care, which corticosteroid is frequently used as an antiemetic adjunct?
- Dexamethasone
- Hydrocortisone
- Fludrocortisone
- Topical betamethasone
Correct Answer: Dexamethasone
Q29. Which monitoring is most important for patients on long-term systemic corticosteroids?
- Bone mineral density assessment (DEXA) to monitor osteoporosis risk
- Monthly lumbar puncture
- Continuous EEG monitoring
- Frequent serum troponin checks
Correct Answer: Bone mineral density assessment (DEXA) to monitor osteoporosis risk
Q30. Regarding topical corticosteroid potency, which ranking is correct from highest to lowest potency?
- Clobetasol > Betamethasone > Hydrocortisone
- Hydrocortisone > Betamethasone > Clobetasol
- Betamethasone > Hydrocortisone > Clobetasol
- All have equal potency regardless of formulation
Correct Answer: Clobetasol > Betamethasone > Hydrocortisone
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
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