Corticosteriods Flashcards
what are the two types of corticosteroids
-mineral corticosteroids
-glucosteriods
what does mineral corticosteroids do?
high fluid retention low anti-inflammatory effect
what does glucosteriods do
low fluid retention and high anti-inflammatory effect
mineral corticosteroid with most activity
fludrocortisone
mineral corticosteroid with second most activity
hydrocortisone
which mineralcorticoid is used as tx for postural hypotension
fludrocortisone
s/e of fludrocortisone
odema
s/e of mineralcorticoids
-sodium + water retention = hypertension
-k+ loss = hypokalaemia
-ca+ loss = hypocalcaemia
Which high potency glucorticoids are neligible with mineralcorticoid effects?
betamethasone and dexamethasone
highest glucocorticoid steroid activity?
dexamethasone
betamethasone
high glucocorticoid steroid activity?
prednisolone
prednisone
deflazacort
glucocorticoids s/e
-diabetes
-osteoporosis
-avascular necrosis of femoral head and muscle
wasting
-gastric ulceration and perforation
what is given alongside long-term steroid tx
PPI
most common corticosteroid s/e
CORTICOSTEROID USE
-cushing syndrome
-osteoporosis
-retardation of growth
-thin skin
-immunosuppression + insomnia
-chorioretinopathy
-oedema
-striae
-emotional disturbance
-rise in BP
-obesity
-increased hair growth (hirsutism)
-diabetes mellitus (hypogly)
-ulcers (peptic)
-suppression (adrenal)
-electrolyte imbalance (hypokal)
MHRA warning with corticosteroids
report blurred vision and visual disturbance
s/e of corticosteriod
symptoms of psychiatric reactions
STOP and SEEK help if:
-insomnia
-instability
-mood change
-suicidal thoughts
-behavioural disturbances
how is adrenal supression caused with cortiocosteriod use?
-prolonged use can cause adrenal atropy (can last yrs even after tx finished)
-abrupt withdrawal can cause acute adrenal insufficiency, hypotension or death
what can occur if there is an temporary increase in dose or temporary reintroduction if stopped?
significant illness
trauma
surgical procedure
corticosteroid s.e
what is infections a cause of?
immunosupression
-serious infections may reach to advanced stage before being recognised
cortiocosteriod s/e
common infections with cortiocosteriod
-chickenpox
-measles
chickenpox as a s/e of corticosteroid
-risk of severe chickenpox unless pt has immunity
-vaccines needed for non-immune pt
-if confirmed needs specialist care and urgent tx
s/e of corticosteroid
measles prophylaxis
-prophylaxis with IM normal immunoglobin PRN
-seek immediate medical advise if exposure occurs
corticosteroid s/e
when to take dose to avoid insomnia
take dose in morning
corticosteroid s/e
s/e in children
retardation of growth
-including oral and inhalation
corticosteroid s/e
what route is thinning skin assoc with
topical
corticosteroid s/e
cushing sydrome symptoms and tx
cushing= too much cortisol
-due to prolonged tx
-moonface, striae, hirustim and acne
-managed with metyrapone
-tx with ketoconazole
striae= stretch marks
managing s/e of corticosteroids
-lowest effect dose for min period
-single dose morning
-if 2DY course = AD
-short courses
-local tx rather than systemic
when corticosteroids gradual withdrawal
-40mg+ or equiv predn OD 1WK
-repeat evening doses
- >3wk tx
-recently repeated course
-taking short course within 1yr of stopping longterm therapy
-other causes of adrenal suppression
topical steroid potency
-mild = hydrocortisone
-moderate = clobetasone
-potent = bethamethasone
-v.potent = clobetasol
which diseases cause adrenal sufficiency?
addisons disease or congential adrenal hyperplasia
adrenal insufficiency tx
hydrocortisone
-can also give fludrocortisone if primary insufficiency
what can adrenal insufficiency lead to?
adrenal crisis
adrenal insufficiency medical emergency tx
hydrocortisone
symptoms of adrenal crisis
severe dehydration
hypokalaemia shock
altered consciousness
seizures
stroke
cardiac arrest
