Corticosteroids Flashcards
In what skin condition should corticosteroids be avoided? Or used only under specialist supervision?
Psoriasis
urticaria
pruritisu - depending
acne - no benefit
What routes are corticosteroids given in UC and crohns?
topically - rectum, locally for haemorrhoids
systemically - mouth, IV
does fludrocortisone have mineralocorticoid or glucocorticoid activity? and what is it used in?
mineralocorticoid
postural hypotension in autonomic neuropathy
Can high dose CC be used in management of septic shock?
No
But lower doses of hydro & fludro is of benefit in adrenal insufficiency resulting from septic shock
do dexamethasone and betamethasone have mineralocorticoid or glucocorticoid activity?
little/no mineralococrticoid
when do glucocorticoids work best and why?
suppressive action on HPA axis is prolonged and greatest when given at night?
what is the overnight dexamethasone test?
diagnoses cushing’s syndrome
given a single dose of dexamethasone at night which is sufficient to inhibit corticotropin secretion for 24 hours
what CC is appropriate where water retention is not wanted?
betamethasone and dexamethasone
can CC be used in management of raised intracranial pressure or cerebral oedema that occurs as a result of malignancy
yes
can CC be used in management of head injury or stroke
no
no benefit/may harm
what CC is used as an adjunct to adrenaline/epineprine in acute hypersensitivity reactions - angioedema/anaphylaxis
hydrocortisone as sodium succinate by IV
when are inhaled CC used
in management of asthma and COPD
when are systemic CC used (airway conditions)
treatment of acute asthma attack
severe cases of chronic asthma
exacerbations of COPD
what are other conditions are CC useful in
autoimmune hepatitis
RA, sarcoidosis
remissions - acquired haemolytic anaemia, nephrotic syndrome, thrombocytopenic purpura
what conditons can CC improve prognosis of but not necessarily cure?
SLE, temporal arteritis, polyarteritis nodosa
MHRA alert with CC
CENTRAL SEROUS CHORIORETINOPATHY
- inhaled, intranasal, epidural, intra-articular, topical dermal, periocular
report any blurred visiion or visual disturbances when CC given by any route
mineralocorticoid s/e
HTN, sodium retention, water retention, potassium loss, calcium loss
CC with mineralocorticoid activity
1) fludrocortisone
2) hydrocortisone, corticotropin, tetracosactide
neglible with high potency glucocorticoids - betamethaosne and dexamethasone
occur only slightly with methylprednisolone, prednisolone, triamcinolone
glucocorticoid s/e
diabetes, osteoporosis, avascular necrosis of femoral had, muscle wasting, peptic ulceration/perforation (weak link), psychiatric reactions
anti-inflammatory
how to take CC to minimise side effects
use lowest effective dose for minimum period possible
The suppressive action of a corticosteroid on cortisol secretion is least when it is given as a single dose in the morning.
the total dose for two days can sometimes be taken as a single dose on alternate days; alternate-day administration has not been very successful in the management of asthma.
intermittent therapy with short courses.
reduce the dose of corticosteroid by adding a small dose of an immunosuppressive drug.
effects of abrupt withdrawal after a prolonged period?
acute adrenal insufficiency, hypotension, death
fever, mylagia, athralgia, rhinitis, conjunctivitis, painful itchy nodules, weight loss
when should gradual withdrawal of systemic CC be considered (in adults)
> 40mg prednisolone OD > 1 week (in children 2 mg/kg daily for 1 week or 1 mg/kg daily for 1 month)
repeat doses in evening
> 3 weeks treatment
repeated courses (esp if > 3week course)
short course within 1 year of stopping long term therapy
other poss causes of adrenal suppression
when can systemic CC be stopped abruptly?
whos disease is unlikely to relapse + treatment < 3 weeks + not included in above pt groups
how to reduce dose during withdrawal
During corticosteroid withdrawal the dose may be reduced rapidly down to physiological doses (equivalent to prednisolone 7.5 mg daily) and then reduced more slowly.
when should steroid emrgency cards be issued
patients with adrenal insufficiency and steroid dependence for whom missed doses, illness, or surgery puts them at risk of adrenal crisis.
- those with primary adrenal insufficiency;
- those with adrenal insufficiency due to hypopituitarism requiring corticosteroid replacement;
- those taking corticosteroids at doses equivalent to, or exceeding, prednisolone 5 mg daily for 4 weeks or longer across all routes of administration (oral, topical, inhaled, intranasal, or intra-articular);
- those taking corticosteroids at doses equivalent to, or exceeding, prednisolone 40 mg daily for longer than 1 week, or repeated short oral courses;
- those taking a course of oral corticosteroids within 1 year of stopping long-term therapy.
can you use topical corticosteroids in routine treatment of urticaria?
no
only be initiated and supervised by a specialist
can you use topic CC in pruritus and acne?
not indiscriminately in pruritus - where only benefit if inflammation is causing the itch
no
name the mild, mod, potent, very potent CC
check phone
equivalent to pred 5mg
betamethasone 750mcg deflazacort 6mg dexamethasone 750mcg hydrocortisone 20mg methylprednisolone 4mg triamcinolone 4mg
