CORTICOSTEROIDS Flashcards
Corticosteroid - side effects
Cushing’s syndrome
Osteoporosis
Retardation of growth
Thin skin
Immunosuppression + Insomnia
Chorioretinopathy
Oedema (water retention)
Striae
Emotional disturbance
Rise in BP (hypertension)
Obesity (truncal)
Increased hair growth (hirsutism)
Diabetes mellitus (hyperglycemia)
Ulcers (peptic)
Suppression (adrenal)
Electrolyte imbalance (hypokalaemia)
MHRA/CHM advice: Central serous chorioretinopathy
Report blurred vision or other visual disturbances
Psychiatric reactions
- Insomnia, irritability, mood change, suicidal thoughts and behavioral disturbances
- Seek medical advice and withdraw treatment
Adrenal suppression + corticosteroids
- Prolonged used 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
Abrupt withdrawal of corticosteroids in adrenal suppression
Abrupt withdrawal = acute adrenal insufficiency, hypotension or death
Significant illness, trauma, or surgical procedure in adrenal suppression
temporary increase in corticosteroid dose, or temporary reintroduction if already stopped
Infection
Infections (due to immunosuppression)
* Serious infections may reach an advanced stage before being recognised
Chickenpox
- Risk of severe chickenpox unless patient developed immunity
- Passive immunisation with varicella-zoster immunoglobulin needed for exposed non-immune patients
- Confirmed chickenpox warrants specialist care and urgent treatment
Measles
- Prophylaxis with IM normal immunoglobulin may be needed
- Seek immediate medical advice if exposure occurs
Insomnia
Take steroids as one dose in the morning
Due to sleep disturbances
Steroids side effects in children
Stunted growth
Even with ICS
Skin thinning
Most common in topical
Apply thinly
Cushing’s Syndrome
Prolonged use
Moon face, striae, hirsutism and acne
Managed with metyrapone, treated with ketoconazole
Managing SEs
- Lowest effective dose for minimum period
- Give as a single dose in the morning
- Total dose for two days can be taken as a single dose on alternate days
- Intermittent therapy with short courses
- Local treatment rather than systemic
- E.g. Creams, intra-articular injections, inhalations, eye-drops, or enemas
Gradually withdraw from steroids if
- More than 40 mg prednisolone (or equivalent) daily for > 1 week
- Repeat evening doses
- > 3 weeks 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 to be given a steroid card