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A - MSRA Drugs [4] > Corticosteroids > Flashcards

Corticosteroids Flashcards

1
Q

Give 3 examples of inhaled corticosteroids?

A
  • Beclomethasone
  • Budesonide
  • Fluticasone
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2
Q

How can systemic corticosteroids be administered?

A
  • IV

- Oral

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3
Q

Give 3 examples of systemic corticosteroids

A
  • Prednisolone
  • Dexamethasone
  • Hydrocortisone
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4
Q

What is mechanism of action of steroids?

A

Reduce inflammation by causing up regulation of anti-inflammatory mediators

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5
Q

What effect do steroids have on the respiratory system

A

Dilates airway and reduces mucosal inflammation and mucus production

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6
Q

How do steroids exert their effects on the respiratory system?

A

Binding to steroid receptors and mimicing the action of cortisol

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7
Q

What are the potential routes of delivery of steroids?

A
  • PO
  • IV
  • Inhaled/nebulised
  • Topical application
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8
Q

What are the indications for the use of corticosteroids?

A
  • Management of obstructive airway disease
  • Exacerbation of asthma or COPD
  • Anaphylaxis
  • Suppression of inflammatory and allergic disease
  • Inflammatory bowel disease
  • Nasal polyps
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9
Q

What mode of delivery is used when steroids are used in the management of obstructive airway disease?

A

Inhaled

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10
Q

What mode of delivery is used when steroids are used for exacerbation of asthma/COPD?

A

Systemic

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11
Q

What steroid is used in the management of inflammatory bowel disease?

A

IV hydrocortisone

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12
Q

What is the role of steroids in nasal polyps?

A

Steroid nasal sprays can help shrink nasal polyps

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13
Q

Can steroids be used in pregnancy?

A

Systemic steroids are contraindicated, but inhaled steroids can be taken as normal in pregnancy and breastfeeding

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14
Q

Why are systemic steroids contraindicated in pregnancy?

A

Risk of IUGR

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15
Q

What monitoring is required with systemic steroids?

A

BP measurement and blood glucose prior to treatment, and intermittently throughout treatment

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16
Q

Why should you monitor BP and BG during treatment for systemic steroids?

A

To monitor cardiovascular and metabolic effects of steroids

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17
Q

What drugs can steroids interact with?

A
  • NSAIDs
  • Anti-hypertensives
  • Anti-diabetic drugs
  • Warfarin
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18
Q

What happens when NSAIDs are taken with steroids?

A

Increased risk of peptic ulceration and bleeding

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19
Q

What happens when anti-hypertensives are taken with steroids?

A

Reduced hypotensive effect

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20
Q

What happens when anti-diabetic drugs are taken with steroids?

A

Steroids antagonise the anti-diabetic effects of these medications

21
Q

What happens when warfarin is taken with steroids?

A

Steroids can increase or decrease anticoagulant effect

22
Q

What are the side effects of inhaled corticosteroids?

A
  • Oral candidiasis
  • Voice hoarseness
  • Growth suppression in children
23
Q

What pneumonic can be used to remember the side effects of corticosteroids?

A

CORTICOSTEROIDS

24
Q

What are the side effects of systemic corticosteroids?

A
  • Cushing’s syndrome
  • Osteoporosis
  • Retardation of growth
  • Thin skin, easy bruising
  • Immunosuppression
  • Cataracts and glaucoma
  • Oedema
  • Suppression of HPA axis
  • Truncal obesity
  • Emotional disturbances
  • Rise in BP
  • Oesophageal and peptic ulceration
  • Increased hair growth (hirsutism)
  • Diabetes mellitus
  • Striae
25
Q

What needs to be considered when thinking about the side effects of corticosteroids?

A

Not all corticosteroids have the same side effects

26
Q

What prophylaxis do patients on long term steroids require?

A
  • Osteoporosis prophylaxis with bisphosphonates

- Gastric ulceration prophylaxis with PPI

27
Q

What is central serous chorioretinopathy?

A

A retinal disorder that has been linked to the systemic use of corticosteroids

28
Q

What recent discovery has been made regarding central serous chorioretinopathy?

A

It has been reported to occur after local administration of corticosteroids via inhaled and intranasal, epidural, intra-articular, topical dermal, and periocular routes

29
Q

What is recommended due to the possibility of central serous chorioretinopathy with the use of steroids?

A

Patients should be advised to report any blurred vision or other visual disturbance with corticosteroid treatment given by any route

30
Q

What should be done if a patient on steroids presents with visual problems?

A

Consider referral to an ophthalmologist

31
Q

What patient counselling is required with inhaled corticosteroids?

A
  • In depth counselling about full side effects
  • Inhaler technique
  • Indication for each inhaler
  • Preventing oral thrush
32
Q

What counselling needs to be given regarding side effects with inhaled corticosteroids?

A

Explain common side effects and discuss risks, including cardiovascular, metabolic, and psychological changes, and the benefits of treatment. Ask patients to report any visual changes

33
Q

What counselling needs to be given regarding inhaler technique with inhaled corticosteroids?

A

Educate patient on appropriate inhaler technique, and review inhaler technique at follow up

34
Q

What can you consider prescribing to make the use of steroid inhalers easier?

A

A spacer, or a breath-actuated inhaler

35
Q

When might you want to prescribe something to make the use of steroid inhalers easier?

A

If it is the first time the patient is being prescribed an inhaler, or if the patient is struggling with using their inhaler

36
Q

What counselling needs to be given regarding the indication for each inhaler with inhaled corticosteroids?

A

Ensure the patient knows when to use each type of inhaler if prescribed multiple inhalers, i.e. preventer and reliever therapy

37
Q

What counselling needs to be given regarding preventing oral thrush with inhaled corticosteroids?

A

Warn patients to gargle with water after using inhaler to prevent oral candidiasis

38
Q

What patient counselling is required with systemic corticosteroids?

A
  • In-depth counselling about full side-effects
  • PPI and bisphosphonates
  • Compliance and withdrawal
  • Steroid treatment card
  • Sick day rules
39
Q

What counselling needs to be given regarding side-effects with systemic corticosteroids?

A
  • Common side effects
  • Risks, including cardiovascular, metabolic, and psychological changes
  • Benefits of treatment
  • Report visual changes
40
Q

What counselling needs to be given regarding PPI and bisphosphonates with systemic corticosteroids?

A

Explain the reason for co-prescribing bisphosphonates and a PPI, and emphasise the importance of compliance to avoid adverse effects with long term steroid treatment

41
Q

What counselling needs to be given regarding compliance and withdrawal with systemic corticosteroids?

A

It is important the patient does not stop taking the steroids unless advised by their doctor

42
Q

How should withdrawal of steroids be done?

A

It should be gradual, and determined on a case-by-case basis

43
Q

What can abrupt withdrawal of steroids potentially cause?

A
  • Adrenal insufficiency
  • Hypotension
  • Death
44
Q

What counselling needs to be given regarding a steroid treatment card with systemic corticosteroids?

A

Patient should be given a steroid treatment card to carry, which contained details of prescriber, drug, dose, and duration

45
Q

What counselling needs to be given regarding sick day rules with systemic corticosteroids?

A

All patients and their partners should receive regular crisis prevention training including verification of steroid emergency card/bracelet and instruction on stress-related glucocorticoid dose adjustment

46
Q

What are the sick day rules for systemic corticosteroids, regarding intercurrent illness?

A

Generally, hydrocortisone should be doubled during intercurrent illness, such as a respiratory infection or fever, until clinical recovery. GI infections may require parenteral hydrocortisone administration

47
Q

What are the sick day rules for systemic corticosteroids, regarding access to acute medical care?

A

Preferably all patients, but particularly patients living or travelling in areas with limited access to acute medical care, should receive a hydrocortisone emergency self-injection kit

48
Q

What are the sick day rules for systemic corticosteroids, regarding serious illness?

A

For major surgery, trauma, delivery, and diseases requiring intensive care unit monitoring, patients should receive IV administration

A - MSRA Drugs [4] (79 decks)

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