Corticosteroid Responsive Conditions

Question 1

What are corticosteroids used for?

Answer 1

Inflammatory long term diseases

Immunosuppressants

Question 2

What are the corticosteroids?

Answer 2

Betamethasone 
Deflazcort
Dexamethasone
Fludrocortisone
Methylprednisolone
Prednisolone
Prednisone
Triamcinolone

Question 3

What are the side effects of dexamethasone?

Answer 3

Anorexia

Raised intracranial pressure

Question 4

What are the side effects of fludrocortisone?

Answer 4

Postural hypotension

Question 5

Which corticosteroids have high mineralcorticoid activity?

Answer 5

Fludrocortisone - most potent

Hydrocortisone

Question 6

What is a side effect of mineralcorticoids?

Answer 6

Fluid retention

Question 7

When is fludrocortisone used?

Answer 7

If fluid retention is beneficial e.g. low blood pressure

Question 8

When is hydrocortisone used?

Answer 8

Not in long term disease suppression due to fluid retention

Useful glucocorticoid on short term basis via IV

Question 9

What are the mineralcorticoid side effects?

Answer 9

Fluid retention
Na+ and water retention - hypertension
K+ Ca2+ loss

Most marked with fludrocortisone
Significant with hydrocortisone, corticotrophin, tetracosactide

Negligible with betamethasone and dexamethasone

Question 10

What is the main effect of glucocorticoids?

Answer 10

Anti inflammatory

Question 11

What are the steroids with high glucocorticoid activity?

Answer 11

Dexamethasone/betamethasone - most potent

Prednisolone/prednisone - significant

Deflazcort - significant

Question 12

When is dexamethasone/betamethasone used?

Answer 12

If fluid retention is a disadvantage - e.g. heart failure

Very little mineralcorticoid activity

Question 13

When is prednisolone/prednisone used?

Answer 13

Prednisolone most common oral steroid

Asthma, COPD, IBD

Question 14

What are the glucocorticoid side effects?

Answer 14

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

Question 15

What are the counselling points for glucocorticoids?

Answer 15

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

Question 16

What are the MHRA warnings for corticosteroids?

Answer 16

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

Question 17

What is the acronym for the corticosteroid side effects?

Answer 17

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

Question 18

How do you manage corticosteroid side effects?

Answer 18

Lowest effective dose
Local treatment
Single dose in the morning 
Alternate day administration 
Intermittently with short courses

Question 19

When do you avoid abrupt withdrawal of corticosteroids?

Answer 19

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

Question 20

Can steroids be taken in pregnancy and breastfeeding?

Answer 20

Generally safe

Monitor fluid retention

Question 21

What are the symptoms of an adrenalectomy and Addison’s disease?

Answer 21

Low cortisol

Low aldosterone

Question 22

What is used to treat adrenalectomy and Addison’s disease?

Answer 22

Hydrocortisone + fludrocortisone

Question 23

What is hypopituitarism?

Answer 23

Pituitary gland does not stimulate hormone secretion by target glands

Question 24

How do you treat hypopituitarism?

Answer 24

Hydrocortisone

Replace other hormones

Question 25

What is Cushing’s syndrome?

Answer 25

Characterised by hypercortisolism (high cortisol)

Question 26

What are the symptoms of Cushing’s Disease?

Answer 26

Skin thinning 
Reddish-purple stretch marks
Striae
Moon face
Acne
Hirsutism

Question 27

What causes Cushing’s Disease?

Answer 27

Corticosteroids

Tumour

Question 28

What is the treatment for Cushing’s Disease?

Answer 28

Ketoconazole

Cortisol inhibiting drugs

Question 29

What are the counselling points for ketoconazole?

Answer 29

Report signs of liver toxicity - anorexia, abdominal pain, dark urine, jaundice, itching, pale stools, nausea and vomiting

Question 30

What are the counselling points for cortisol inhibiting drugs?

Answer 30

Adrenal insufficiency - report fatigue, anorexia, nausea, vomiting, hypotension

Adrenal suppression causes hyponatraemia, hyperkalaemia and hypoglycaemia