When caring for a 13-year-old with muscular dystrophy receiving corticosteroids to slow disease progression, which of the following medication side effects would you assess for? (Select All that Apply.)

Choice A rationale Corticosteroids like prednisone can significantly impact the central nervous system, leading to various neuropsychiatric side effects, including mood lability, irritability, anxiety, and depression. This is due to their influence on neurotransmitter systems and hypothalamic-pituitary-adrenal axis regulation, altering emotional processing and behavior in patients. Choice B rationale Chronic fatigue is not a typical side effect of corticosteroid use; in fact, corticosteroids often have an energizing effect due to their role in metabolism and stress response. Fatigue might be associated with the underlying disease progression in muscular dystrophy but is not a direct pharmacological consequence of steroid administration. Choice C rationale Corticosteroids typically promote weight gain rather than weight loss. This is due to their effects on metabolism, including increased appetite, fluid retention, and redistribution of fat to the trunk and face (Cushingoid appearance). They can also lead to increased glucose production and insulin resistance, contributing to metabolic changes. Choice D rationale Long-term corticosteroid therapy significantly increases the risk of osteoporosis. This occurs because glucocorticoids inhibit osteoblast activity (bone formation), stimulate osteoclast activity (bone resorption), decrease calcium absorption in the gut, and increase urinary calcium excretion, leading to a net loss of bone mineral density and increased fracture risk. Choice E rationale Weight gain is a common and well-documented side effect of corticosteroid therapy. This is primarily attributed to increased appetite, fluid retention secondary to mineralocorticoid effects, and altered fat distribution. Patients often experience an increase in truncal obesity and facial puffiness.