Corticosteroids

Question 1

MHRA/CHM warning with local and systemic use:

Answer 1

Chorioretinopathy

(visual disturbances, blurred vision) - refer

Question 2

Side effects of mineralcorticoids

• use in Addison’s disease, postural hypotension
  e. g. fludro/hydro

Answer 2

Sodium and water retention
Hypertension
Potassium/calcium loss

Question 3

Side effects of glucocorticoids

• anti-inflammatory properties/reduce immune response
  e. g. pred/dexa,beta

Answer 3

Diabetes
OP
Psychiatric reactions
Muscle wasting
GI ulceration

Question 4

Managing side effects

Answer 4

Lowest effective dose

Single dose in the morning

Question 5

Adrenal suppression

80% due to Addison’s disease

Answer 5

Adrenal glands do not produce enough CCS (A+C)

Question 6

Key hormones secreted by the adrenal cortex:

Answer 6

Aldosterone and cortisol (A+C) which regulate Na+ and K+ and water retention

Question 7

Signs and symptoms of adrenal suppression

Answer 7

Weight loss, salt craving, fatigue, N+V and hypotension, low Na+, high K+ and low glucose

Question 8

How to minimise side effects of CCS?

Answer 8

1. Take in the morning as a single dose
2. Use the lowest dose, shortest time
3. Local treatment is preferred
4. Short course
5. Use a spacer for inhalers

Question 9

Side effects:

Answer 9

1. Adrenal suppression - prolonged use/abrupt withdrawal
2. Infection
3. Psychiatric reactions e.g. suicidal thoughts, insomnia
4. Chickenpox (give v.z immuno)
5. Measles - avoid exposure

Question 10

When to reduce CCS gradually?

Answer 10

1. Received 40mg + pred for 1 week
2. Repeated doses in the evening
3. Received more than 3 weeks of treatment
4. Received repeated courses
5. Taken a short course within 1 year of stopping :T treatment

Question 11

Important to carry…

Answer 11

A steroid card (on LT treatment)