Corticosteroid responsive conditions Flashcards
What are the two types of corticosteroids ?
those that have high mineralocorticoid activity (fluid retention) and those that have high glucocorticoid activity( high anti-inflammatory effects)
If corticosteroid have high mineralocorticoid activity what side effects would you expect?
fluid retention ( Na and water retention) K and Ca loss
In what conditions is fludrocortsone beneficial and why ?
Fludrocortisone has most potent mineralocorticoid activity.
In conditions where fluid retention is beneficial e.g. low BP, adrenal insufficiency due to septic shock
Anti-inflammatory effect of no clinical relevance
Why hydrocortisone is not used long term in disease suppression?
Because it has significant amount of mineralocorticoid activity which will lead to fluid retention and thats why only used for short term basis via IV in surgeries or emergencies e.g. life threatening asthma or thyrotoxicosis.
Which two steroids have negligible mineralocorticoid side effects?
Bethamethsaone, dexamethasone
Which two steroids have highest glucocorticoid activity ?
dexamethasone and bethamethasone are most potent, therefore used if fluid retention is a disadvantage e.g. HF, liver failure, renal failure
Which two steroids have significant glucocorticoid activity ?
prednisolone/prednisone
deflazcort
What are glucorticoid side effects?
Endocrine ( hyperglycaemia)
osteoporosis ( > 3 months use: prophylaxis with bisphosphonates)
muscle wasting, proximal myopathy: caution with statins
Peptic ulcers, dyspepsia: take with or after food
Psychiatric reactions: especially in high doses, paranoid state or depression with suicide risk while taking or during withdrawal, can cause mood changes like euphoria,insomina, delusion, nightmares
immunosuppression infections
adrenal suppression:risk one year after stopping
Glucocorticoids cause immunsupression that can lead to infections, so what advice you would give regarding it ?
avoid close contact to chickenpox or shingles, exposed non-immune patients need passive immunisation with varicella booster vaccine. This applies to those who are currently taking it and those who have stopped in the last 3 months.
avoid exposure to measles
What skin side effects glucorticoids can cause ?
skin thinning, purple-red strae, bruising
What eye side effects glucocorticoids can cause ?
glaucoma, cataracts
rare risk of central serous chorioretinopathy with local and systemic use
what side effects can high doses of glucocorticoids cause ?
Cushing syndrome
what CNS side effects can glucocorticoids cause ?
aggravated epilepsy, schizophrenia
what are important patient counselling points for people who are on steroids ?
risk of infections
adrenal supresion
psychiatric reactions
withdrawal of corticosteroids
How would you best advise to manage corticosteroids side effects ?
lowest effective dose
local treatment over systemic
single dose in the morning
alternate days of administration intermittently with short course