Corticosteroids Flashcards
Where are mineralcorticoids used
Mineralcorticoid – minerals like sodium, potassium, calcium and fluid (water) regulation.
Mineral = water. Examples = Fludrocortisone, hydrocortisone, aldosterone
What is glucocorticoid activity
Glucocorticoid activity = anti-inflammatory/reduced immune response.
Examples = Betametasone, dexamethasone, methylprednisolone, prednisolone, triamcinolone
What can be used when fluid retention is an issue?
Betamethasone and dexamethasone
Are corticosteroids used for anaphylaxis management?
No
Are corticosteroids used in COPD
Yes
What is the MHRA advice on corticosteroids?
MHRA/CHM advice:
Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration
Report blurred vision
What are some minercorticoid side effects
- hypertension
- sodium retention
- water retention
- potassium loss
- calcium loss
What is the worst mineralcorticoid for side effects
Fludrocortisone
Name some glucocorticoid side effects
- 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
What is the management of side effects from corticosteroids?
Lowest dose, shortest time
Single dose in morning
Opt for local treatment instead of systemic.
Give spacers etc for inhalers
What is adrenal suppression
Condition in which adrenal glands do not produce adequate amounts of corticosteroids (primarily cortisol i.e. hydrocortisone)
Side effects of adrenal suppression
- Fatigue
- Anorexia
- N&V
- Hypotension
- Hyponatremia
- Hyperkalaemia
- Hypoglycaemia
- Salt craving
Can you use corticosteroids in pregnancy?
No
How should you withdraw corticosteroids?
Gradually
What is fludrocortisone used for
Postural hypotension
Which corticosteroid has both glucocorticoid and mineralcorticoid activities
Hydrocortisone
What should everyone carry
A steroid card
How can corticosteroids affect children
Affect their growth
What is used to replace aldoesterone?
Fludrocortisone
What is used to replace cortisol
Hydrocortisone
What should be monitored in corticosteroid treatment
- 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
What are some warning signs to look out for
- Paradoxical bronchospasm (constriction of the airways)
- Uncontrolled asthma (cough, wheeze, tight chest)
- Adrenal suppression
The metabolism of steroids can be accelerated by what?
Carbamazepine, Phenobarbital, phenytoin and rifamycin
What do corticosteroids do to the effect of coumarins
Enhance the anticoagulation effect
Should you use corticosteroids with live vaccines
No - can impair immune response to vaccines, avoid concomitant use with live vaccines
What do corticosteroids do with gastrointestinal effects of NSAIDs
Masks the gastrointestinal effects of NSAIDs - avoid concomitant use - avoid gastroprotection
When can hypokalemia be severe with corticosteroids?
When given with other drugs that lower serum potassium e.g. loop and thiazide diuretics
