Corticosteroids Flashcards
corticosteroid uses
~ inflammatory
~ immunosuppressants
corticosteroid e.g.
~ betamethasone
~ deflazcort
~ dexamethasone (palliative; anorexia, raised intracranial pressure)
~ Fludrocortisone (postural hypotension)
~ hydrocortisone (surgery/emergencies e.g. anaphylaxis)
~ methylprednisolone
~ prednisolone (Asthma , copd, ibd, eczema)
~ prednisone
~ triamcinolone
high mineralocorticoid activity =
fluid retention
mineralocorticoid
~ Fludrocortisone = most potent
– if fluid retention good – in low BP e.g. neuropathic postural hypotension, adrenal insufficiency due to septic shock
~ Hydrocortisone
NOT for long term
– good for short-term via IV in surgeries / emergencies e.g. asthma, thyrotoxicosis
mineralocorticoid SE
Na & water retention = HTN
K & Ca LOSS
high glucocorticoid activity =
Anti-inflammatory
glucocorticoid
~ Dexa/betamethasone ~ most potent
— used if fluid retention disadvantage e.g. HF
– little mineralocorticoid activity
~ Prednisolone ~ significant
– most common PO e.g. asthma ,COPD, IBD
~ deflazcort - significant
glucocorticoid SEs
- Endocrine
~ diabetes (hyperglycaemia) - Musculoskeletal
~ osteoporosis (>3m use; prophylaxis bisphosphonates)
~ muscle wasting (mypoathy, caution with statins) - GI
~ ulcers, irritation, dyspepsia (take with food) - Psychiatric reactions
~ mood change, depression , paranoid state. report ! - Infection (immunosuppression)
- Adrenal suppression ~ 1y after stopping
- Ophthalmic
~ cataracts / glaucoma
~ MHRA alert - Skin
~ skin thinning, bruising, striae - CNS
~ aggravated EP, SZ - Growth suppression in kids
- Cushing’s in high doses
Adrenal suppression SE of corticosteroids
fatigue, anorexia, N, V, hypONatraemia, hypotension, hypERKalaemia, hypOGlycaemia
~ avoid abrupt withdrawal if >3 weeks
~ higher doses in illness/stress
Mnemonic corticosteroid side effects
ACHING BOSOM
A = adrenal suppression, appetite larger, abrupt withdrawal reaction
C = cushings, cataracts
H = hyperglycaemia, hyperlipidaemia
I = infections, insomnia
N = NS, psychiatric reaction
G = Glaucoma, GI ulcers
B = BP increase HTN
O = Osteoporosis
S = skin thinning
O = obesity
M = muscle wasting
MHRA warning for methylprednisolone injection
~ contains lactulose; avoid in cows milk allergy
how to manage steroid SE
~ lowest effective dose for minimum period
~ local tx then systemic
~ single dose in morning (suppressive action on cortisol least in morning)
~ alternative day administration by taking 2 days worth in single dose
~ intermittently with short course
Withdrawal of steroids
~ avoid abrupt withdrawal
– long term use >3weeks
– >40mg prednisolone daily or equivalent for more than 1 week
– repeat doses taken in EVE
– recent repeated courses
– short courses within 1y of stopping long term steroids
— other causes of adrenal suppression
Steroids in pregnancy / BF
generally safe
~ monitor fluid retention
Steroids counselling & requirements
- PIL to every pt on systemic steroids
- counsel on
- risk of infections
- adrenal suppression
- psychiatric reactions
- withdrawal of steroids
steroid card given to
~ long-term steroid >3 weeks
~ if >ICS
