Corticosteroids Flashcards
What is meant by mineral steroids
High fluid retention, low anti-inflammatory effect
Highest mineral corticosteroid activity = fludrocortisone
Hydrocortisone also has high activity
Fludrocortisone used to treat postural hypotension
What are the mineral corticosteroid side EFFECTS
Sodium and water retention = hypertension
Potassium loss = hypokalaemia
Calcium loss = hypocalcaemia
Mineral corticosteroids side effects are negligible with the high potency glucocorticoid: betamethasone and dexamethasone
What is meant by glucocorticoid steroids
High anti-inflammatory effect, low fluid retention
Highest glucocorticoid steroid activity = dexamethasone/ betamethasone
- prednisalone, prednisone and deflazacort also has high activity
What are the side effects of glucocorticoid steroids side effects
Diabetes
Osteoporosis- osteoporotic fractures
A vascular necrosis of the femoral head and muscle wasting
Gastric ulceration and perforation
In the elderly who is on a steroid for long term put them on a PPI such as omeprazole or if someone is on ssri, or warfarin
Use lansoprazole with clopidogrel not omeprazole
What is the MHRA warning about regarding corticosteroids
MHRA warning:
Central serous chorioretinopathy
- report blurred vision or other visual disturbances
Side effects:
Psychiatric reactions
- insomnia, irritability, mood changes, suicidal thoughts and behavioural disturbances
- seek medical advice and withdraw treatment
What is the side effects of corticosteroids
Side effects:
Psychiatric reactions
- insomnia, irritability, mood changes, suicidal thoughts and behavioural disturbances
- seek medical advice and withdraw treatment
Adrenal suppression
Prolonged use can lead to adrenal atrophy ( can last years after treatment ends)
Abrupt withdrawal = acute adrenal insufficiency, hypotension or death
Significant illness, trauma, or surgical procedure = temporary increase in corticosteroid dose, or temporary reintroduction if already stopped
What other side effects of corticosteroids
Infections ( due to immunosuppression)
- significant infections may reach an advanced stage before being recognised
Chickenpox
- risk of severe chickenpox unless patient developed immunity
-passive immunity with varicella-zoster immunoglobulin needed for exposed mon-immune patients
-confirmed chickenpox warrants specialist care and urgent treatment
Measles
-prophylaxis with intramuscular normal immunoglobulin may be needed (vaccine)
-seek immediate medical advice if exposure occurs
Insomnia
-take steroids as one dose in the morning as this is when your cortisol is produced
Children
-stunted growth, even with inhaled corticosteroids
Skin thinning- most common in topical administration
Prolonged use can lead to Cushing syndrome
-moon face, striae, hirsutism and acne
-managed with metyrapone, treated with ketoconazole
What is the acronym for the side effects of corticosteroids use
CORICOSTEROIDUSE
Cushing syndrome
Osteoporosis
Retardation of growth
Thin skin
Immunosupression + Inomnia
Chorioretinopathy
Oedema (water Retention)
Striae
Emotional disturbance
Rise in BP (hypertension)
Obesity (Truncal)
Increased in hair growth (hirsutism)
Diabetes mellitus (hyperglycaemia)
Ulcers (peptic)
Suppression (adrenal)
Electrolyte imbalance (hypokalaemia)
How do you manage the side effects of corticosteroids
Lowest effective dose for minimum period
Given as a single dose in the morning
Total dose for 2 days can be taken as a single dose on alternate days
Intermittent therapy with short courses
Local treatments rather than systemic
- eg creams, intra-articular injections, inhalation, eye drops or enemas
When do you AVOID ABRUPT WITHDRAWAL OF STEROIDS
If:
- more than 40mg prednisalone (or equivalent) daily for > 1 weeks
-repeat evening doses
- >3 week treatment
- recently received repeated courses
-taken a short course within 1 year of stopping long term therapy
-other possible causes of adrenal suppression
ALL ENTITLED PATIENTS ARE GIVEN A STEROID CARD
What are the different potencies for topical steroids
Mild: hydrocortisone
Moderate: clobetasone
Potent: betamethasone
Very potent: clobetasol
What is meant by adrenal INSUFFICIENCY
Caused by addisons disease or congenital adrenal hyperplasia
- treated with mainly hydrocortisone
— primary adrenal insufficiency treated with fludrocortisone as well
Can lead to adrenal crisis
- severe dehydration, hypovolaemic shock, altered consciousness, seizures, stroke, or cardiac arrest- death if untreated
- medical emergency- treated with hydrocortisone (mineral corticosteroid) treats the hypotension
