CORTICOSTEROIDS Flashcards

1
Q

Corticosteroid - side effects

A

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)

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2
Q

MHRA/CHM advice: Central serous chorioretinopathy

A

Report blurred vision or other visual disturbances

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3
Q

Psychiatric reactions

A
  • Insomnia, irritability, mood change, suicidal thoughts and behavioral disturbances
  • Seek medical advice and withdraw treatment
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4
Q

Adrenal suppression + corticosteroids

A
  • 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
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5
Q

Abrupt withdrawal of corticosteroids in adrenal suppression

A

Abrupt withdrawal = acute adrenal insufficiency, hypotension or death

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6
Q

Significant illness, trauma, or surgical procedure in adrenal suppression

A

temporary increase in corticosteroid dose, or temporary reintroduction if already stopped

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7
Q

Infection

A

Infections (due to immunosuppression)
* Serious infections may reach an advanced stage before being recognised

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8
Q

Chickenpox

A
  • 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
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9
Q

Measles

A
  • Prophylaxis with IM normal immunoglobulin may be needed
  • Seek immediate medical advice if exposure occurs
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10
Q

Insomnia

A

Take steroids as one dose in the morning
Due to sleep disturbances

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11
Q

Steroids side effects in children

A

Stunted growth
Even with ICS

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12
Q

Skin thinning

A

Most common in topical
Apply thinly

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13
Q

Cushing’s Syndrome

A

Prolonged use
Moon face, striae, hirsutism and acne
Managed with metyrapone, treated with ketoconazole

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14
Q

Managing SEs

A
  • 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
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15
Q

Gradually withdraw from steroids if

A
  • 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
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16
Q

Topical steroid potencies

A

Mild: Hydrocortisone
Moderate: Clobetatone
Potent: Betamethasone
Very Potent: Clobetasol

17
Q

Dexamethasone

A

Used in palliative care.
Anti-inflammatory (reduces swelling/inflammation caused by tumour)
Appetite stimulation (prevents weight loss in those with anorexia due to the cancer)
N + V (particularly when it is caused by increase intracranial pressure/chemo regime)

18
Q

Hydrocortisone

A

Surgery
Emergencies e.g. anaphylaxis

19
Q

Fludrocortisone

A

Postural hypotension

20
Q

Prednisolone

A

Asthma
COPD
IBD
Severe eczema