Corticosteroids

Question 1

Where are mineralcorticoids used

Answer 1

Mineralcorticoid – minerals like sodium, potassium, calcium and fluid (water) regulation.

Mineral = water. Examples = Fludrocortisone, hydrocortisone, aldosterone

Question 2

What is glucocorticoid activity

Answer 2

Glucocorticoid activity = anti-inflammatory/reduced immune response.

Examples = Betametasone, dexamethasone, methylprednisolone, prednisolone, triamcinolone

Question 3

What can be used when fluid retention is an issue?

Answer 3

Betamethasone and dexamethasone

Question 4

Are corticosteroids used for anaphylaxis management?

Answer 4

No

Question 5

Are corticosteroids used in COPD

Answer 5

Yes

Question 6

What is the MHRA advice on corticosteroids?

Answer 6

MHRA/CHM advice:

Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration

Report blurred vision

Question 7

What are some minercorticoid side effects

Answer 7

• hypertension
• sodium retention
• water retention
• potassium loss
• calcium loss

Question 8

What is the worst mineralcorticoid for side effects

Answer 8

Fludrocortisone

Question 9

Name some glucocorticoid side effects

Answer 9

• Diabetes
• Osteoporosis
• High doses are associated with avascular necrosis of the femoral head
• Muscle wasting
• Peptic ulceration and perforation
• Psychiatric reactions

Diabetic bodybuilders are psychos who get stomach ulcers from eating broken bones

Question 10

What is the management of side effects from corticosteroids?

Answer 10

Lowest dose, shortest time

Single dose in morning

Opt for local treatment instead of systemic.

Give spacers etc for inhalers

Question 11

What is adrenal suppression

Answer 11

Condition in which adrenal glands do not produce adequate amounts of corticosteroids (primarily cortisol i.e. hydrocortisone)

Question 12

Side effects of adrenal suppression

Answer 12

• Fatigue
• Anorexia
• N&V
• Hypotension
• Hyponatremia
• Hyperkalaemia
• Hypoglycaemia
• Salt craving

Question 13

Can you use corticosteroids in pregnancy?

Answer 13

No

Question 14

How should you withdraw corticosteroids?

Answer 14

Gradually

Question 15

What is fludrocortisone used for

Answer 15

Postural hypotension

Question 16

Which corticosteroid has both glucocorticoid and mineralcorticoid activities

Answer 16

Hydrocortisone

Question 17

What should everyone carry

Answer 17

A steroid card

Question 18

How can corticosteroids affect children

Answer 18

Affect their growth

Question 19

What is used to replace aldoesterone?

Answer 19

Fludrocortisone

Question 20

What is used to replace cortisol

Answer 20

Hydrocortisone

Question 21

What should be monitored in corticosteroid treatment

Answer 21

• blood pressure
• blood lipids
• serum potassium
• body weight and height in children and adolescents (growth can be slowed)
• bone mineral density
• blood glucose
• eye exam (for intraocular pressure, cataracts)
• signs of adrenal suppression

Question 22

What are some warning signs to look out for

Answer 22

• Paradoxical bronchospasm (constriction of the airways)
• Uncontrolled asthma (cough, wheeze, tight chest)
• Adrenal suppression

Question 23

The metabolism of steroids can be accelerated by what?

Answer 23

Carbamazepine, Phenobarbital, phenytoin and rifamycin

Question 24

What do corticosteroids do to the effect of coumarins

Answer 24

Enhance the anticoagulation effect

Question 25

Should you use corticosteroids with live vaccines

Answer 25

No - can impair immune response to vaccines, avoid concomitant use with live vaccines

Question 26

What do corticosteroids do with gastrointestinal effects of NSAIDs

Answer 26

Masks the gastrointestinal effects of NSAIDs - avoid concomitant use - avoid gastroprotection

Question 27

When can hypokalemia be severe with corticosteroids?

Answer 27

When given with other drugs that lower serum potassium e.g. loop and thiazide diuretics