Corticosteroid

Question 1

What is the MHRA/CHM advice for systemic administration of corticosteroids?

Answer 1

The side effect is Chorioretinopathy.

So report any blurred vision or visual disturbances.
Refer to an ophthalmologist.

Question 2

What is Mineralocorticoid activity?

Answer 2

Mineral (Sodium, potassium, calcium) and water balance.
The regulation of these two things in the body.

Question 3

What is Glucocorticoid?

Answer 3

An anti-inflammatory / reduced immune response

Question 4

Examples of Mineralocorticoid hormones?

Answer 4

1. Fludrocortisone
2. Hydrocortisone (cortisol)

Question 5

Examples of Glucocorticoid hormones?

Answer 5

1. Betamethasone
2. Dexamethasone
3. Methylprednisolone
4. Prednisolone
5. Triamcinolone

Question 6

What are the side effects of Glucocorticoid?

Answer 6

1. Diabetes
2. Osteoporosis (esp in elderly)
3. Muscle wasting (proximal myopathy)
4. Linked with peptic ulceration & perforation
5. Psychiatric reactions

Question 7

What are the side effects of Mineralocorticoid?

Answer 7

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

Question 8

What is Adrenal suppression/insufficiency?

Answer 8

A condition where the adrenal glands do not produce adequate corticosteroids, primarily cortisol, and also aldosterone (mineralocorticoid), which regulates Na+, K+ and water retention.

80% due to Addison’s disease.

Question 9

What are the signs and symptoms of adrenal suppression?

Answer 9

• Hyponatraemia
• Sal craving
• Fatigue
• Anorexia / weight loss
• Nausea & vomiting

Question 10

How are the side effect of corticosteroids managed?

Answer 10

• Using the lowest dose for a short time.
• Give as a single dose in the morning
• Use for only a short course
• For higher doses, use large volume spacer devices.

Question 11

What does the Adrenal cortex secrete?

Answer 11

• Hydrocortisone (cortisol)
• Aldosterone

Question 12

What can be done to increase the benefits of high glucocorticoid activity?

Answer 12

Accompany it with a low mineralocorticoid activity.

Question 13

What is Prednisolone commonly used for by mouth?

Answer 13

Long term disease suppression

Question 14

What are examples of drugs with a very high glucocorticoid activity?

Answer 14

Betamethasone & Dexamethasone - both have long duration of action.

So can be used in high dose therapy which fluid retention is not required.

Question 15

What are some of the side effects of systemic corticosteroids?

Answer 15

1. Retinal disorder - so report any blurred vision or visual disturbances
2. Adrenal suppression - caused by prolonged used, abrupt withdrawal.
3. Infection - because prolonged use can increase susceptibility to & severity of infections. Also fungal or viral ocular infections can get worse.
4. Psychiatric reactions - high doses are linked with mood changes, suicidal thoughts etc. This can occur when medication is withdrawn. Patients must seek medical advice is depression or suicidal thoughts occur.
5. Chickenpox - immunisation with varicella zoster immunoglobulin is needed.
6. Measles - avoid exposure to measles.
7. Musculoskeletal & Ophthalmic effects can also occur.

Question 16

Which patients should have corticosteroids reduced gradually instead of abruptly?

Answer 16

In patients whose disease is unlikely to relapse and have:
1. Received > 40mg pred (or equivalent

2. Had repeated doses in the evening
3. Received more than 3 weeks treatment
4. Recently received repeat courses (esp if taken for less than 3 weeks)
5. Taken short course within 1 year of stopping long term therapy
6. Has conditions or drugs that can cause adrenal suppression