Corticosteroids Flashcards

1
Q

Mineralocorticoid steroid-

A
  • High fluid retention,low anti inflammatory effect
    • Highest mineralocorticoid steroid activity =fludrocortisone
    • Hydrocortisone - also high activity
    • Fludrocorticoid steroid used to treat postural hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Mineralocorticoid steroid side effects

A
  • Sodium and water retention = hypertension
    • Potassium loss = hypokalaemia
    • Calcium loss = hypocalcaemia
      Mineralocorticoid effects are negligible with high potency glucocorticoid -betamethasone and dexamethasone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Glucocorticoid steroid:

A

High anti inflammatory effects,low fluid retention
Highest glucocorticoid steroid activity = dexamethasone/betamethasone
- Prednisolone,prednisone,deflazacort also have high activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Side effects
Glucocoids

A

Diabetes
Osteoporosis- osteoporotic fractures
Avascular necrosis of the femoral head and muscle wasting
Gastric ulceration and perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ALL CORTICOSTEROID SIDE EFFECTS:
Mhra advice???

A

MHRA/CHM advice: Central serous chorioretinopathy
- Report blurred vision or other visual disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Psychiatric reactions:

A
  • Insomnia,irritability,mood change,suicidal thoughts and behavioural disturbances
    • Seek medical advice and withdraw treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Adrenal suppression -
Can lead to what kind of atrophy? Abrupt withdrawal causes what? Significant illness or trauma can cause what? What happens with surgery or trauma

A

-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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Infections due to immunosuppression? What do we do?

A

Infections - due to immunosuppression
- Serious infection may reach an advanced stage before being recognised
- Chicken pox:
- Risk of severe chickenpox unless patient developed immunity
- Passive immunisation with varicella- zoster immunoglobulin needed for exposed non immune patients
- Confirmed chickenpox warrants specialist and urgent care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Measles:

A
  • Prophylaxis with intramuscular normal immunoglobulin may be needed
    • Seek immediate medical advice if exposure occurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Insomnia- steroid should be taken in….
Height,skin,moon what can we treat it with?

A
  • Take steroid as one dose in the morning (when cortisol is produced)
    • Children: stunned growth even with inhaled corticosteroid
    • Skin thinning - most common in topical admin
    • Prolonged use can lead to Cushing’s syndrome
    • = moon face,striae,hirsutism and acne
    • Managed with metyrapone,treated with ketoconazole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CORTICOSTEROID SE

A

Crushing syndrom
Osteoporosis
Retardation of growth
Thin skin
Immunosupression and insomnia
Chorioretinopathy
Odema
Striae
Emotional disturbance
Rise in BP - hypertension
Obesity - truncal
Increased hair growth - Hirsutism
Diabetes Mellitus
Ulcers peptic
Suppression - adrenal
Electrolyte imbalance - hypokalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Managing side effects:
Lowest dose for how long? Give a single dose when? Total dose for two days can be taken when? Intermittent therapy with what?

A
  • Lowest effective dose for minimum period
    • Give 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 rather than systemic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Gradually withdraw if…

A
  • More than 40mg prednisolone (or equivalent) daily for more than 1 week
    • Repeat evening doses
    • Treatment for longer than 3 weeks
    • Recently received repeated courses within 1 year old stopping log term therapy
    • Other possible causes of adrenal suppression
    • All entitled patients to be given a steroid card
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Topical steroid

A

Rd - diluted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Topical steroid scale

A

Mild - Hydrocortisone
Moderate- Clobetasone
Potent - betamethasone
Very potent - clobetasol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Adrenal insufficiency - cause by Addison’s disease or congenital adrenal hyperplasia
What do we treat it with??? What can primary adrenal insufficiency be treated with? What can adrenal crisi lead to ?

A

Treat with- hydrocortisone
- Primary adrenal insufficiency treated with fludrocortisone as well
- Can lead to adrenal crisis - severe dehydration,hypovolaemic shock, altered consciousness,severe seizures,stroke or cardiac arrest - death if untreated
- Medical emergency - treat with hydrocortisone