Corticosteroids Flashcards
Monitoring
Blood pressure, blood lipids, serum potassium, body weight and height (in children and adolescents),
bone mineral density, blood glucose, eye exam (for intraocular pressure, cataracts), signs of adrenal
suppression
Warning Signs
• Paradoxical bronchospasm (constriction of the airways)
• Symptoms of uncontrolled asthma e.g. cough, wheeze, tight chest
• Frequent courses of antibiotics and/or oral corticosteroids
• Adrenal suppression e.g. nausea, vomiting, weight loss, fatigue, headache, muscular weakness
• Immunosupression e.g. chicken pox, measles, oral candidiasis, more serious infections e.g.
TB, septicaemia, ocular fungal or viral infections
• Psychiatric reactions e.g. suicidal thoughts, nightmares, depression, insomnia
Actions Required
• Advise patient to report immediately to a doctor if any warning signs occur
• Give the patient a steroid treatment card if long-term treatment is required. Explain that they
must not stop treatment abruptly after prolonged treatment (> 3 weeks)
• Check the patient is taking oral steroids in the morning as a single dose
• Ensure that patients rinse their mouth or clean their teeth after using inhaled corticosteroids
• If the patient has not had chicken pox and measles in the past, advise them to avoid anyone
with these infections
Interactions
• Metabolism of corticosteroids accelerated by carbamazepine, phenobarbital, phenytoin and
rifamycins
• Corticosteroids may induce or enhance anticoagulant effect of coumarins
• High dose corticosteroid can impair immune response to vaccines; avoid concomitant use
with live vaccines
• Corticosteroids can mask the gastrointestinal effects of NSAIDs (including aspirin); avoid
concomitant use if possible and consider gastroprotection
• Hypokalaemia can be severe when given with other drugs that lower serum potassium e.g.
loop and thiazide diuretics
• Effects if antihypertensive and oral hypoglycaemic drugs are antagonized by glucocorticoids
