Corticosteroids

Question 1

True or false:

• Oral glucocorticoids are absorbed in the Duodenum

Answer 1

False

Absorbed in the Jejunum

Question 2

True or false

Concomitant food intake with oral glucocorticoids reduces the total amount abosorped

Answer 2

False

It may delay absorption, but does not decrease the amount absorbed

Question 3

What are the side effects of SHORT term steroid therapy?

Answer 3

Mood changes, anxiety, insomnia
GI intolerance (N/V)
Hyperglycaemia
Fluid and sodium retention
Increased appetite
Acneiform eruptions
Increased infections
Amenorrhea
Muscular weakness
Impaired wound healing

Question 4

What are the side effects of LONG term steroid therapy?

Answer 4

MSK
- Osteoporosis
- Osteonecrosis
- Growth retardation
- Muscle atrophy
- Myopathy

Ophthalmic
- Cataracts
- Glaucoma
- Exophthalmos
- Infection

GIT
- N/ V
- GORD / Esophagitis / Peptic ulcers
- Pancreatitis
- Intestinal perforation

Metabolic
- Hyperglycaemia
- Hyperlipidaemia
- Obesity
- Hypocalcaemia
- Hypokalaemic acidosis

Cardiovascular
- HTN
- Peripheral Oedema
- Atherosclerosis

Haemotologic:
- Neutrophillia
- Lymphopaenia
- Eosinopaenia
- Immunopsupression

CNS
- Mood and personality changes
- Psychosis
- Seizures
- Peripheral neuropathy
- Pseudotumour cerebri

Cutaneous:
- atrophy, striae, telangectasia
- Vascular fragility
- purpura
- Acne
- Hirsuitism
- Infections

HPA axis supression
- adrenal crisis

Gyanecologic
- amenorrhea

Question 5

How long do you need to be taking steroids for before osteoporosis is an issue?

Answer 5

Rapid decline occurs in the first 3 months of usage

Rate of loss peaks at 6 months

Question 6

True of False

Alternate morning treatment schedule for steroids reduces the risk of osteoporosis

Answer 6

False

It does NOT reduce the risk of Osteoporosis or cataracts

Question 7

True or False

Trabecular bone is more prone to demineralisation than cortical bone with chronic steroid use.

Answer 7

True

Trabecular bone = axial skeleton, has a higher turnover rate than cortical bone (long bones), and is therefore more susceptible.

Question 8

How often should you do DEXA scans on patients on long term steroids?

Answer 8

Baseline and every 1 -3 years

Question 9

What are the benefits of alternate morning glucocorticoid therapy?

Answer 9

Decreases risk of:
- myopathy
- growth suppression
- HTN
- opportunistic infection
- electrolyte imbalance

Does NOT affect osteoporosis or cataract risk

Fluctuating BGLs in diabetes make this method unsuitable.

Question 10

What are the key differences between steroid induced myopathy and myosiits?

Answer 10

Myositis
- weakness often WITH pain
- Elevated CK
- signs of muscle inflammation and oedema
- gets worse as steroids are weaned

Myopathy:
- often WITHOUT pain
- normal CK
- signs of atrophy WITHOUT inflammation
- gets better after 3 -4 weeks of dose reduction / cessation