Chapter 6: Endocrine: Diabetes Insipidus & Corticosteroids Flashcards
High doses of corticosteroids are used to save or prolong life. Give examples of conditions they are used in (4).
- Exfoliative dermatitis
- Pemphigus
- Acute leukaemia
- Acute transplant rejection
Why should doses be kept as low as possible in chronic diseases?
To minimise side effects
Which route of administration is commonly used to treat inflammatory skin conditions?
Topical
Through which three routes are corticosteroids used in crohn’s disease and ulcerative colitis to induce remission?
- IV
- Oral
- Rectal
Which corticosteroid has the least mineral corticoid action?
Dexatmethasone
Which corticosteroid has the most mineral corticoid action?
Fludrocortisone
Put the following corticosteroids in order of increasing mineral corticoid action: Hydrocortisone, Bethamatsone, Prednisolone
Betamethasone
Predinisolone
Hydrocortisone
At which time of day should corticosteroids be given to have the greatest suppression of corticotropin release?
At night
What is the test for Cushing’s syndrome called?
Overnight dexamethasone test
What is Cushing’s syndrome?
Chronic excess glucocorticodis
Give 3 causes of Cushing’s syndrome
- Adrenal tumour
- Exogenous corticosteroids
- Excess ACTH secretion from anterior pituitary
What is a common cause of raised intracranial pressure and cerebal oedema?
Malignancy
Which corticosteroids are used to treat raised intracranial pressure and cerebal oedema? (2)
- Dexamethasone
2. Betamethasone
Are steroids used in head injury or stroke?
No
IV hydrocortisone can be used with adrenaline/epinepherine for the emergency treatment of what?
Anaphylaxis
Inhaled corticosteroids are licensed for use of which respiratory diseases? (3)
- Asthma
- COPD
- Allergic rhinitis (nasal congestion)
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?
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
At which time of day is the suppressive action of corticosteroids on cortisol the least?
First thing in the morning
Why are we worried about giving corticosteroids to children?
Adrenal suppression can lead to reduced growth velocity
What can we supply with ICS to those under 15? Why?
Spacer devices
Increase airway deposition and reduce orapharyngeal deposition
Which two hormones are secreted by the adrenal cortex?
- Cortisol (Glucocorticoid - some mineralcorticoid activity)
- Aldosterone (mineral corticoid)
In cortisol deficiency states (e.g. Addison’s disease), which 2 steroids are given?
- Hydrocortisone
2. Fludrocortisone
To mimic the normal diurnal rhythm of steroid secretion, how is oral hydrocortisone for the treatment of Addison’s Disease dosed?
Larger morning dose, Small evening dose
+ Fludrocortisone
What is used to treat acute adrenal insufficiency?
IV hydrocortisone