Corticosteroids Flashcards
Gradual withdrawal required if > _____mg predinisolone equivalent is given for more than 1 week
> 40 mg
True or false: steroids should be gradually withdrawn if treatment exceeds 3 weeks
TRUE
Which type of corticosteroid causes diabetes as a side effect (mineralocorticoids or glucocorticoids)
Glucocorticoids
True or false: psychiatric reactions may occur with corticosteroid use
TRUE
More likely with glucocorticoids
Includes suicidal thoughts, insomnia and psychosis
Mineralocorticoid side effects (5 points)
Hypertension Sodium retention Water retention Potassium loss Calcium loss
Betamethasone is a _____ potency glucocorticoid
HIGH potency
True or false: Dexamethasone is a potent mineralocorticoid
FALSE - Dexamethasone is a high potency glucocorticoid
True or false: corticosteroids are associated with fractures
TRUE
Osteoporosis can be due to glucocorticoid use = increased risk of fragility fractures
______ is the only naturally secreted mineralocorticoid
Aldosterone
Which drug is used for:
A) mineralocorticoid replacement
B) glucocorticoid replacement
A) Fludrocortisone
B) Hydrocortisone
Note: hydrocortisone does have mineralocorticoid activity but this is not enough for replacement in Addison’s.
May still cause mineralocorticoid side effects in other conditions so don’t use long term
True or false:
Regarding corticosteroid replacement in Addison’s disease, the larger dose of hydrocortisone is taken in the evening
FALSE
The larger dose is taken in the morning with a smaller dose at night to mimic the diurnal rhythm of cortisol secretion
Monitor _____ and _____ in children receiving corticosteroid treatment (annually)
Height and Weight
Corticosteroids may cause growth retardation
Which corticosteroid is used to treat croup
Dexamethasone
______ can be used to treat postural hypotension
Fludrocortisone
Should both glucocorticoids and mineralocorticoids be given in hypopituitarism?
No
As aldosterone production is also regulated by RAAS (not just the pituitary) there is no deficiency of mineralocorticoids in hypopituitarism
Most potent glucocorticoids? (2 points)
Betamethasone and Dexamethasone
Abrupt withdrawal of corticosteroids after prolonged therapy may lead to acute ____________
Adrenal insufficiency
May also need to hypotension and in some cases, death
True or false: steroids do not need to be gradually withdrawn in those who had repeated doses only in the evening
FALSE
This is one of the criteria for a slow withdrawal
A red, puffy, rounded face or a ‘buffalo hump’ are signs of _________
Cushing’s syndrome
What are some of the signs of adrenal crisis
Headache. Fatigue. Nausea and Vomiting. Low blood pressure. Dehydration. Rapid, shallow breathing. Pale, sweaty and clammy skin
What are the 5 criteria that would require gradual withdrawal of corticosteroid treatment ?
(To prevent adrenal crisis)
- > 40mg prednisolone equivalent for at least 1 week
- > 3 weeks steroid treatment
- Repeated doses in the evening
- Repeated courses (especially if > 3 weeks in length)
- Short course of steroids taken within a year of stopping long term therapy
