Corticosteroid Responsive Conditions Flashcards
What are corticosteroids used for?
Inflammatory long term diseases
Immunosuppressants
What are the corticosteroids?
Betamethasone Deflazcort Dexamethasone Fludrocortisone Methylprednisolone Prednisolone Prednisone Triamcinolone
What are the side effects of dexamethasone?
Anorexia
Raised intracranial pressure
What are the side effects of fludrocortisone?
Postural hypotension
Which corticosteroids have high mineralcorticoid activity?
Fludrocortisone - most potent
Hydrocortisone
What is a side effect of mineralcorticoids?
Fluid retention
When is fludrocortisone used?
If fluid retention is beneficial e.g. low blood pressure
When is hydrocortisone used?
Not in long term disease suppression due to fluid retention
Useful glucocorticoid on short term basis via IV
What are the mineralcorticoid side effects?
Fluid retention
Na+ and water retention - hypertension
K+ Ca2+ loss
Most marked with fludrocortisone
Significant with hydrocortisone, corticotrophin, tetracosactide
Negligible with betamethasone and dexamethasone
What is the main effect of glucocorticoids?
Anti inflammatory
What are the steroids with high glucocorticoid activity?
Dexamethasone/betamethasone - most potent
Prednisolone/prednisone - significant
Deflazcort - significant
When is dexamethasone/betamethasone used?
If fluid retention is a disadvantage - e.g. heart failure
Very little mineralcorticoid activity
When is prednisolone/prednisone used?
Prednisolone most common oral steroid
Asthma, COPD, IBD
What are the glucocorticoid side effects?
Endocrine - diabetes (hyperglycaemia)
MSK - osteoporosis ( > 3 months use - prophylaxis with bisphosphonates)
Muscle wasting - caution with statins
GI - peptic ulcers, irritation, dyspepsia
Psychiatric reactions
Immunosuppresion
Adrenal suppression
Glaucoma, cataracts
Skin thinning, bruising
Aggravated epilepsy, schizophrenia
Growth destruction
Cushing’s syndrome
What are the counselling points for glucocorticoids?
Take with or after food
Report psychiatric reactions e.g. paranoia/depression immediately
Avoid close contact with chickenpox or shingles (currently taking and stopped < 3 months)
Avoid exposure to measles and seek immediate medical advice if exposed
Avoid abrupt withdrawal if use > 3 weeks
Mention if taken steroids in less than a year during any treatment for illness or injury
Report blurred vision and visual disturbances
What are the MHRA warnings for corticosteroids?
Rare risk of central serous chorioretinopathy with local and systemic use - report blurred vision and visual disturbances
Methylprednisolome injectable medicine contains lactose - don’t use in patients with cows milk allergy
What is the acronym for the corticosteroid side effects?
Adrenal suppression, abrupt withdrawal reactions Cushing’s syndrome, cataracts Hyperglycaemia, hyperlipidaemia Infections, insomnia Nervous system - psychiatric reactions Glaucoma, GI ulcers Blood pressure increase Osteoporosis Skin thinning Obesity Muscle wasting
How do you manage corticosteroid side effects?
Lowest effective dose Local treatment Single dose in the morning Alternate day administration Intermittently with short courses
When do you avoid abrupt withdrawal of corticosteroids?
Long term use > 3 weeks
> 40mg prednisolone daily or equivalent for more than 1 week
Repeat doses taken in evening
Recent repeated courses
Short course within 1 year of stopping long term steroids
Other causes of adrenal suppression
Can steroids be taken in pregnancy and breastfeeding?
Generally safe
Monitor fluid retention
What are the symptoms of an adrenalectomy and Addison’s disease?
Low cortisol
Low aldosterone
What is used to treat adrenalectomy and Addison’s disease?
Hydrocortisone + fludrocortisone
What is hypopituitarism?
Pituitary gland does not stimulate hormone secretion by target glands
How do you treat hypopituitarism?
Hydrocortisone
Replace other hormones
What is Cushing’s syndrome?
Characterised by hypercortisolism (high cortisol)
What are the symptoms of Cushing’s Disease?
Skin thinning Reddish-purple stretch marks Striae Moon face Acne Hirsutism
What causes Cushing’s Disease?
Corticosteroids
Tumour
What is the treatment for Cushing’s Disease?
Ketoconazole
Cortisol inhibiting drugs
What are the counselling points for ketoconazole?
Report signs of liver toxicity - anorexia, abdominal pain, dark urine, jaundice, itching, pale stools, nausea and vomiting
What are the counselling points for cortisol inhibiting drugs?
Adrenal insufficiency - report fatigue, anorexia, nausea, vomiting, hypotension
Adrenal suppression causes hyponatraemia, hyperkalaemia and hypoglycaemia
