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BNF > Chapter 6: Endocrine: Diabetes Insipidus & Corticosteroids > Flashcards

Chapter 6: Endocrine: Diabetes Insipidus & Corticosteroids Flashcards

1
Q

High doses of corticosteroids are used to save or prolong life. Give examples of conditions they are used in (4).

A
  1. Exfoliative dermatitis
  2. Pemphigus
  3. Acute leukaemia
  4. Acute transplant rejection
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2
Q

Why should doses be kept as low as possible in chronic diseases?

A

To minimise side effects

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3
Q

Which route of administration is commonly used to treat inflammatory skin conditions?

A

Topical

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4
Q

Through which three routes are corticosteroids used in crohn’s disease and ulcerative colitis to induce remission?

A
  1. IV
  2. Oral
  3. Rectal
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5
Q

Which corticosteroid has the least mineral corticoid action?

A

Dexatmethasone

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6
Q

Which corticosteroid has the most mineral corticoid action?

A

Fludrocortisone

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7
Q

Put the following corticosteroids in order of increasing mineral corticoid action: Hydrocortisone, Bethamatsone, Prednisolone

A

Betamethasone
Predinisolone
Hydrocortisone

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8
Q

At which time of day should corticosteroids be given to have the greatest suppression of corticotropin release?

A

At night

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9
Q

What is the test for Cushing’s syndrome called?

A

Overnight dexamethasone test

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10
Q

What is Cushing’s syndrome?

A

Chronic excess glucocorticodis

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11
Q

Give 3 causes of Cushing’s syndrome

A
  1. Adrenal tumour
  2. Exogenous corticosteroids
  3. Excess ACTH secretion from anterior pituitary
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12
Q

What is a common cause of raised intracranial pressure and cerebal oedema?

A

Malignancy

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13
Q

Which corticosteroids are used to treat raised intracranial pressure and cerebal oedema? (2)

A
  1. Dexamethasone

2. Betamethasone

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14
Q

Are steroids used in head injury or stroke?

A

No

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15
Q

IV hydrocortisone can be used with adrenaline/epinepherine for the emergency treatment of what?

A

Anaphylaxis

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16
Q

Inhaled corticosteroids are licensed for use of which respiratory diseases? (3)

A
  1. Asthma
  2. COPD
  3. Allergic rhinitis (nasal congestion)
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17
Q

What is the rule of thumb to ensure side effects of corticosteroids are kept low?

What is another option (not successful in asthma)?

And a third option?

A fourth?

A fifith?

A

Use the lowest effective dose for a minimum time

Alternate day administration

Short-course therapy

Adding a small dose of immunosuppressive drug to reduce steroid dose required

Topical/Local application > systemic

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18
Q

At which time of day is the suppressive action of corticosteroids on cortisol the least?

A

First thing in the morning

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19
Q

Why are we worried about giving corticosteroids to children?

A

Adrenal suppression can lead to reduced growth velocity

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20
Q

What can we supply with ICS to those under 15? Why?

A

Spacer devices

Increase airway deposition and reduce orapharyngeal deposition

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21
Q

Which two hormones are secreted by the adrenal cortex?

A
  1. Cortisol (Glucocorticoid - some mineralcorticoid activity)
  2. Aldosterone (mineral corticoid)
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22
Q

In cortisol deficiency states (e.g. Addison’s disease), which 2 steroids are given?

A
  1. Hydrocortisone

2. Fludrocortisone

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23
Q

To mimic the normal diurnal rhythm of steroid secretion, how is oral hydrocortisone for the treatment of Addison’s Disease dosed?

A

Larger morning dose, Small evening dose

+ Fludrocortisone

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24
Q

What is used to treat acute adrenal insufficiency?

A

IV hydrocortisone

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25
Q

What is used to treat hypopituitarism? Are mineral corticoids required? What other additional therapy is required?

A
  1. Glucocorticoids
  2. Mineral corticoids not required as aldosterone can be stimulated via RAAS
  3. Levothyroxine and Sex hormones
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26
Q

What is diabetes insipidus?

A

A condition where too much urine is produced

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27
Q

What can be a fatal effect of uncontrolled diabetes insipidus?

A

Dehydration

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28
Q

What is the name of the hormone used to treat diabetes insipidus? (has two names)

A

Antidiuretic hormone or Vasopressin

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29
Q

What is the analogue of vasopressin?

A

Desmopressin

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30
Q

What are the 3 advantages of desmopressin over vasopressin?

A
  1. More potent
  2. Longer duration
  3. No vasoconstriction
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31
Q

Other than in diabetes insipidus, which other condition can desmopressin be used in?

A

Nocturnal enuresis

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32
Q

Other than in diabetes insipidus, which other condition can vasopressin be used in?

A

To control variceal bleeding in portal hypertension

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33
Q

In the body, what releases ADH?

A

Posterior pituitary

34
Q

The posterior pituitary releases desmopressin and which other hormone?

A

Oxytocin

35
Q

Which elecetrolyte imbalance does inappropriate secretion of antidiuretic hormone cause?

A

Hyponatreamia

36
Q

If fluid restriction alone does not work, name 2 antidiuretic hormone antagonists used in SIADH

A

Democlocycline

Tolvaptan

37
Q

What is a serious neurological event that can occur with rapid correction of hyponatreamia?

A

Osmotic demylination

38
Q

What is the counselling advice to give to patients taking desmopression? (2)

A

To avoid fluid overload. To stop taking if they experience vomiting or diarrhoea

39
Q

Can intranasal desmopressin be used for nocturnal enuresis?

A

No, increased risk of side effects

40
Q

What most be measured before starting treatment with desmopressin OR tolvaptan and regularly throughout?

A

Baseline sodium

41
Q

If plasma sodium falls below normal range, is the dose of desmopressin reduced?

A

No, discontinue treatment

42
Q

As well as osmotic demylination, what can hyponatreamia cause?

A

Convulsions

43
Q

High glucocorticoid activity is only an advantage when accompanied by relatively low what?

A

Mineralcorticoid activity

44
Q

Which corticosteroid has an anti inflammatory activity which is of no clinical relevance?

A

Fludrocortisone

45
Q

Apart from fludrocortisone, which corticosteroid has high mineralcorticoid activity making it unsuitable for long term disease prevention?

A

Hydrocortisone

46
Q

Give 3 conditions in which hydrocortisone is used

A
  1. Adrenal replacement therapy
  2. Emergency treatment of some conditions (e.g. anaphylaxis)
  3. Topical management of inflammatory conditions
47
Q

What is the most commonly used corticosteroid for disease suppression?

A

Prednisolone

48
Q

Which 2 corticosteroids have high glucocorticoid activity and insignificant mineralcorticoid activity?

A
  1. Dexamethasone

2. Betamethasone

49
Q

Which 2 corticosteroids are particularly useful in suppression of corticotropin secretion?

A
  1. Dexamethasone

2. Betamethasone

50
Q

Why should steroids be avoided in active systemic infection?

A

Can make it worse by dampening immune response

51
Q

During prolonged systemic treatment with steroids, what can occur?

A

Adrenal suppression

52
Q

How long can adrenal suppression persist for after stopping treatment with corticosteroids?

A

Years

53
Q

Which 3 events can abrupt withdrawal after prolonged treatment with corticosteroids cause?

A
  1. Acute adrenal insufficiency
  2. Hypotension
  3. Death
54
Q

What are the signs and symptoms of adrenal suppression? (8)

A
  1. Fatigue
  2. Anorexia
  3. Nausea
  4. Vomiting
  5. Hypotension
  6. Hyponatreamia
  7. Hyperkalemia
  8. Hypoglycaemia
55
Q

If a person is on prolonged corticosteroid treatment, in which 3 conditions do we need to increase the dose to compensate for diminished adrenocorticol response?

A
  1. Significant illness
  2. Trauma
  3. Surgical procedure
56
Q

Which healthcare professional MUST know if a patient is taking corticosteroids to avoid a massive fall in blood pressure during anaesthesia or immediately post-op?

A

Anesthetists

57
Q

What should patient on long-term corticosteroids carry with them at all times?

A

A steroid card

58
Q

What information is contained in a steroid card? (5)

A
  1. Guidance on minimising risk
  2. Prescriber
  3. Drug
  4. Dosage
  5. Duration of treatment
59
Q

What does prolonged courses of corticosteroids increase susceptibility to?

A

Infections

60
Q

Why can serious infections (e.g. septicaemia and TB) reach an advanced stage before being recognised in patients taking corticosteroids?

A

Corticosteroids can make clinical presentation to infections atypical.

61
Q

Which type of infections can corticosteroids exacerbate? (2)

A
  1. Fungal

2. Occular (e.g. herpes virus)

62
Q

If they have never had it, which childhood condition are patients on oral or parenteral corticosteroids at high risk of?

A

Chicken pox

63
Q

When patients on corticosteroids get chicken pox, a rash is not necessarily a prominent feature, how else can it manifest? (3)

A
  1. Pneumonia
  2. Hepatitis
  3. Disseminated intrvascular coagulation
64
Q

If a patient taking corticosteroids presents to your community pharmacy with chicken pox, what is the most appropriate response?

A

Hospital for specialist care and urgent treatment

65
Q

As well as chicken pox, which other childhood illness should patients taking corticosteroids avoid?

A

Measles

66
Q

Patients taking high doses of systemic corticosteroids should be aware of which side effect?

A

Psychiatric reactions

67
Q

What are they symptoms of psychiatric reactions seen in patients taking high dose systemic corticosteroids? (8)

A
  1. Euphoria
  2. Nightmares
  3. Insmonia
  4. Irritability
  5. Mood swings
  6. Suicidal thoughts
  7. Psychotic reactions
  8. Behavioural disturbances
68
Q

As well as during treatment with corticosteroids, when else can psychiatric reactions occur?

A

On withdrawal

69
Q

Can corticosteroids be used in pregnancy?

A

Yes

70
Q

Why are we comfortable with using corticosteroids in pregnancy?

A

No convincing evidence that they increase incidence of congenital abnormalities such as cleft lip/palate

71
Q

When used long term, what is a risk of corticosteroids in pregnancy?

A

Intra-uterine growth restrictions

72
Q

What are the glucocorticoid side effects of corticosteroids? (7)

A
  1. Diabetes
  2. Oestoporosis (especially in the elderly, can cause hip fractures)
  3. Avascular necrosis of the femoral head
  4. Muscle wasting
  5. Peptic ulcerations and perforation
  6. Psychiatric reactions
  7. Increased risk infection
73
Q

What are the mineralcorticoid side effects of corticosteroids? (5)

A
  1. Hypertension
  2. Sodium retention
  3. Water retention
  4. Potassium loss
  5. Calcium loss
74
Q

What must be monitored annually in children taking corticosteroids?

A

Height

75
Q

As well as adrenal suppression, what else can abrupt withdrawal of corticosteroids be associated with? (6)

A
  1. Fever
  2. Myalgia
  3. Weight loss
  4. Rhinitis
  5. Conjunctivitis
  6. Painful itchy skin nodules
76
Q

What are the criteria for gradual withdrawal of corticosteroids? (5)

A
  1. > 40mg daily prednisolone (or =) for over 1 week
  2. Repeat doses in the evening
    3, Over 3 weeks of treatment
  3. Recently received repeat courses
  4. Taken a short course within 1 year of stopping long term
77
Q

What is the first line treatment of most types of Cushing’s?

A

Surgical intervention

78
Q

If Cushing’s cannot be treated surgically, which 2 drugs have been found to be helpful?

A
  1. Metyrapone

2. Ketoconazole

79
Q

If a patient with Cushing’s is receiving a high dose of Metyrapone, what will they also need?

A

Cortisol replacement

80
Q

What is a potentially life threatening side effect of ketoconazole?

A

Hepatotoxicity

81
Q

Which 3 things must be monitored with ketocolazole treatment?

A
  1. ECG
  2. Adrenal function
  3. LFTs

BNF (28 decks)

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