Corticosteroids

Question 1

What are the main effects glucocorticoids have on the body

Answer 1

Carbohydrate, Fat, Protein metabolism
Anti-inflammatory properties
Immunosuppresive
Anti-proliferative
Vasoconstrictive effects

Question 2

What are the main effects of mineralcorticoids like aldosterone

Answer 2

Regulation of electrolyte and water balance

Question 3

What are the mineral corticoid side effects

Answer 3

Hypertension 
Sodium Retention
Water retention
Potassium loss
Calcium loss

Question 4

What are the glucocorticoid side effects

Answer 4

Diabetes
Osteoporosis (elderly) 
Necrosis of femoral head
Proximal myopathy
Psychiatric reactions
Cushing's syndrome
Weight gain/ increased appetite

Question 5

How long is the duration before a patient should receive a steroid card

Answer 5

More than 3 weeks

Question 6

What are the warning signs to watch out for in steroids

Answer 6

• Paradoxical bronchospasm (constriction of airways)
• Uncontrolled asthma (cough, wheeze, tight chest)
• Adrenal suppression (can lead to hypotension and death, includes fever, nausea, vomiting, weight loss, fatigue, headache, muscular weakness)
• Frequent courses of steroids/antibiotics
• Immunosuppression
• Psychiatric reactions (aggravation of epilepsy or schizophrenia)

Question 7

When should gradual withdrawal of corticosteroids be considered

Answer 7

Those who have received more than 40mg prednisolone daily for more than one week

Been given repeat evening doses

Received treatment for more than 3 weeks

Question 8

What should you monitor for in corticosteroid treatment

Answer 8

Blood pressure
Blood lipids
Serum Potassium
Body weight and height in children and adolescents
Bone mineral density
Blood glucose
Eye exam (intraocular pressure, cataracts)
Signs of adrenal suppression

Question 9

Can you take corticosteroids during pregnancy and breast feeding

Answer 9

The benefit outweighs the risk
Women with fluid retention should be monitored closely
Treatment is required during labour

Question 10

What are the main drug interactions corticosteroids have

Answer 10

• Metabolism accelerated by carbamazepine, phenobarbital, phenytoin, rifamycins
• Corticosteroids may induce or enhance anti-coagulant effect of coumarins
• High dose can impair immune response to vaccines; avoid use with live vaccines
• Mask GI effects of NSAIDS, avoid concomitant use and consider gastroprotection if possible
• HYPOKALEMIA when given with drugs that lower potassium levels (loop and thiazide diuretics)
• Anti-hypertensives and oral hypoglycaemic drugs are antagonised by glucocorticoids