Corticosteroids

Question 1

corticosteroid uses

Answer 1

~ inflammatory
~ immunosuppressants

Question 2

corticosteroid e.g.

Answer 2

~ 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

Question 3

high mineralocorticoid activity =

Answer 3

fluid retention

Question 4

mineralocorticoid

Answer 4

~ 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

Question 5

mineralocorticoid SE

Answer 5

Na & water retention = HTN
K & Ca LOSS

Question 6

high glucocorticoid activity =

Answer 6

Anti-inflammatory

Question 7

glucocorticoid

Answer 7

~ Dexa/beta-methasone ~ most potent
— used if fluid retention disadvantage e.g. HF
– little mineralocorticoid activity

~ Prednisolone ~
– most common PO e.g. asthma ,COPD, IBD

Question 8

glucocorticoid SEs

Answer 8

1. Endocrine
   ~ diabetes (hyperglycaemia)
2. Musculoskeletal
   ~ osteoporosis (>3m use; prophylaxis bisphosphonates)
   ~ muscle wasting (mypoathy, caution with statins)
3. GI
   ~ ulcers, irritation, dyspepsia (take with food)
4. Psychiatric reactions
   ~ mood change. report !
5. Infection (immunosuppression)
6. Adrenal suppression ~ 1y after stopping
7. Ophthalmic
   ~ cataracts / glaucoma
8. Skin
   ~ skin thinning, bruising
9. CNS
   ~ EP, SZ aggrevated
10. Growth suppression in kids
11. Cushings

Question 9

Adrenal suppression SE of corticosteroids

Answer 9

fatigue, anorexia, N, V, hypONatraemia, hypotension, hypERKalaemia, hypOGlycaemia

~ avoid abrupt withdrawal

Question 10

Mnemonic corticosteroid side effects

Answer 10

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

Question 11

MHRA warning for steroids

Answer 11

~ methylprednisolone injectable contains lactulose; avoid in cows milk allergy

Question 12

how to manage steroid SE

Answer 12

~ lowest effective dose for minimum period
~ local tx then systemic
~ single dose in morning (suppressive action on cortisol is least in morning)
~ alternative day administration
~ intermittently with short course

Question 13

Withdrawal of steroids

Answer 13

~ 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

Question 14

Steroids in pregnancy / BF

Answer 14

generally safe
~ monitor fluid retention