addisons disease and adrenal insufficiency

Question 1

glucorticoids - systemic; what are the indiations

Answer 1

• treat allergic or ifnlammatory disorders e.g. asthma, anaphylaxis
  2. supress autoimmune disease e.g. IBD, Arthritis
  3. treat some cancers - as part of chemo or to reduce tumour associated swelling.
  4. hormone replacement in adrenal insufficiency or hypopituitarism

Question 2

MOA glucorticorticoids (systemic)

Answer 2

modify immune response
upregulate antinflammatory genes and downregulate proinflammatory fe genes.

metabolically - increase gluconeogenesis and have mineralocrticoid effect = na and h20 retention

Question 3

SE of systemic glucorticoids aka steroids

Answer 3

• immunosurpession
• DM and osteoporosis
• increased catabolism = proximal muscle weakness, skin thinning, easy bruising, gastritis
• mood and behaviour change including insomnia
• HTN, hypok+, oedema

LTM = Adrenal atrophy = acute addisonian crisis

withdraw = fatigue, weight loss and arthralgia

Question 4

who should you use systemic steroids carefully in

Answer 4

kids

those with infection

Question 5

interactions of systemic steroids

Answer 5

• NSAIDs = combined = peptic ulcer and bleed.
• B3 agonists, theophylline, loop/thiazides = hypokalaemia enhanced
• cyp450i - Reduced action
• vaccines; steroids reduce effect.

Question 6

name common systemic glucocorticoids

Answer 6

prednisolone
hydrocortisone
dexamethasone

Question 7

most potent glucorticoids out of most common

Answer 7

dexamethasone.

Question 8

what can you co prescribe with systemic steroids to reduce osteoporotic and GI effects

Answer 8

bisphosphonates, PPI

Question 9

when should patients take systemic steroids

Answer 9

in mornign to match circadian rythym