Corticosteroid Adverse Effects Flashcards

1
Q

CS opthalmic adverse effects may include…

Typical eyedrop side fx, but also an immunosuppressant, so watch for…

A

Stinging, redness, tearing, burning
Secondary infection

Cataracs, glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

inhalation of CS adverse effects may include…

What do we council people for asthma?

A

Thrush
Hoarseness, dry mouth
Dysphoria
Trouble swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Inhaled CS adverse effects can be minimized by…

A

Rinsing mouth after usage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Nasal instillation CS adverse effects include…

A

Rhinorrhea, sneezing
Burning
Bloody nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Nasal CS adverse effects can be minimized, via…

A

Pointing away from the nasal septum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Topical CS adverse effects include…

A

Skin atrophy
Spider veins
Burning/Irritation

Tachyphylaxis possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Early manifestations of CNS effects from CS include…

A

Euphoria
Insomnia
Restlessness
Memory Impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Late manifestations of CNS effects from CS’s include…

A

Altered mood: depression, mania, psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CNS effects of CS are often ____ and go away when ____

A

Dose-related; go away when discontinuing the medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CS may provoke opthalmic issues via…

A

Increasing intraocular pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Eye conditions that CS can cause or worsen include…

A

Cataracts
Glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

These kinds of CS have higher risk of developing/worsening opthalmic issues…

A

Topical CS - opthalmic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Risk factors for developing or worsening cataracts include…

A

Daily dosing, cumulative dosing, long duration, older age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Development of cataracts from CS adverse effect is…

Permanent or not?

A

Irreversible; therefore routine eye exams are important for long-term CS users

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Risk factors that may increase risk of worsening/developing glaucoma with CS include…

Involves other medical conditions

A

Pre-existing condition or family history, diabetes, RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Onset of glaucoma usually occurs…

Is it permanent?

A

Within weeks, and subsides when discontinued

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hypercortisolism alters normal fat distribution, which manifests as…

A

Centripetal obesity

AKA cushingoid features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The signs of centripetal obesity are…

A

Moon face
Buffalo hump
Protuberant abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Cushingoid features onset usually occurs ____ and is usually dependent on ____

A

First couple months - usually dose and duration dependent

Discontinuation of CS usually resolves symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

GI side effects from CS include…

What could be done to help with this?

A

GI upset, dyspepsia - Take with food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

CS used in conjunction with NSAID’s may increase risk of…

A

Peptic ulcer disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Increases in BG occur with oral CS use, due to…

A

induction of gluconeogenesis and decreased utilization of glucose by the tissues

Also has effect on glucagon and catecholamines

Can happen in people with or without diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Effect on BG from CS usage is…

Outcome?

A

Usually mild - dose related

More common in prednisone doses >15 mg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Elevated BG from CS may persist…

A

For months upon discontinuation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Sodium + water retention from CS usage occurs because of…

A

The variety of actions CS may have on the kidney and its vasculature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which CS’s are most likely to cause fluid retention and elevate BP?

A

Greatest mineralocorticoid activity; cortisone, hydrocortisone, etc.

27
Q

Effects on sodium + water retention from CS usually resolves…

A

Upon discontinuation

28
Q

Increased appetite from CS is typically seen with…

What kind of CS therapy

A

High dose therapy

29
Q

Dose dependency for adverse effects of CS refers to…

A

Duration and frequency of use
Strength/potency of CS

30
Q

Growth retardation may occur due to various CS effects on growth, such as…

A

Decreasing osteoblasts and GH secretion
Competitively inhibiting insulin receptors

31
Q

Effects of growth patterns with CS in children are…

Most common with???

A

Dose-dependent and most pronounced with oral therapy

May affect final height

32
Q

HPA-axis suppression can occur when exogenous CS are administered, because…

A

Exogenous CS will cause negative feedback of CRH and ACTH

33
Q

HPA-Axis suppression means that…

A

No endogenous cortisol will be produced due to disruption of the HPA-axis cycle

34
Q

In periods of acute stress, cortisol…

A

is released more than usual (up to 10x)

35
Q

If HPA-axis suppression is present, what happens if a patient abruptly stops their CS or becomes severely ill?

A

Hypotension, hypoglycemia
Flu-like symptoms
Weight loss
Confusion

Essentially reverse of too much CS adverse effect

Remember that CS helps regulate inflammation, immunity, as well as a lot of other things

36
Q

Various factors that may predict occurrence of HPA-axis suppression include…

A

Dose, potency, and duration of steroid use
Interval (QID more likely than OD)
Route + time of administration (morning follows physiologic cortisol release)

37
Q

HPA-axis suppression will invariably occur with maintenance dosing of…

Prednisone

A

> 15mg/day

37
Q

When predicting HPA-axis suppression, what is a good rule of thumb to follow?

A

High doses for longer durations = higher risk for suppression

38
Q

Screening is recommended for those taking oral CS for…

How long?

A

More than 2 consecutive weeks or more than 3 weeks over the past 6 months

39
Q

Alongside duration of use, HPA-axis suppression should be tested in patients with…

How is the patient feeling?

A

Unexplained symptoms after steroid withdrawal

40
Q

The SST is used to determine HPA-axis suppression, and dose this by…

A

Giving patient synthetic ACTH, and measuring plasma cortisol levels

41
Q

Estimated duration for recovery of HPA-axis suppression is…

A

Between 1-3 years after cessation of exogenous steroids

42
Q

CS may increase suspectibility to infection, due to…

A

Impairment of antibodies, phagocytosis, and wound healing

Viral, bacterial, fungal

43
Q

Effects on the immune system with CS use typically occur in patients who…

A

Are chronically taking CS or on high dose CS

44
Q

CS may impact skin + connective tissue, via…

A

Inhibiting epidermal cell division and DNA synthesis

45
Q

Effects of CS on skin + connective tissue result in…

A

Acne, bruising
Thin skin
Striae
Impaired wound healing

46
Q

Thin skin from CS is…

Reversible or not

A

Typically reversible, usually resolving with discontinuation

47
Q

Striae resulting from CS is…

A

Not reversible

48
Q

CS has multiple effects on bone, such as…

A

Protein catabolism, osteoblast and GH inhibition
Lowered calcium absorption and reabsorption from kidney

Bone Loss

49
Q

Bone loss with CS occurs most rapidly…

Duration of time

A

In the first 3 months, and peaks at 6 months

50
Q

Degree of bone loss correlates to _____

A

Dose and duration

Risk increases with doses as low as 2.5-7.5 mg/day
Systemic therapy for 2-3 months = major risk factor for bone loss + facture

51
Q

For all adults initiating or continuing CS therapy over 2.5mg/day for 3+ months, this should be performed:

A

Fracture risk assessment

52
Q

GIOP stands for…

A

Glucocorticoid-induced osteoporosis

53
Q

Osteonecrosis refers to…

A

Death of bone tissue due to impaired blood supply

54
Q

Symptoms of necrosis usually develop…

A

After a few months to a few years

55
Q

Risk of osteonecrosis increases with both…

A

Dose and duration of CS

56
Q

Long term users of CS should be asked about…

A

Joint pain
Range of motion

57
Q

Muscle weakness may occur with CS usage due to…

A

Decreased proten synthesis in the muscle (catabolic effect)

58
Q

Muscle issues with CS is more common with…

A

Prolonged courses of high-dose CS (prednisone >10mg/day)

59
Q

Muscle weakness is usually characterized by…

A

Arm and leg weakness, after several weeks to months of use

60
Q

Long-term side fx of CS in kids usually involve…

A

Weight gain
Growth retardation
Cushingoid features

61
Q

Long-term adverse effects of CS in kids usually occurs after…

A

15+ days of treatment

62
Q

The most serious adverse effect with long-term CS usage in kids is…

A

Risk of infection due to immunosuppressant properties

63
Q

Short-course adverse effects with CS in kids usually involves…

A

Vomiting
Behavioural changes
Sleep disturbances

Serious adverse effects are uncommon