Corticosteroids - Prednisolone Flashcards

1
Q

What are corticosteroids like prednisolone used for?

A

1) allergic or inflammatory disorders e.g. anaphylaxis / asthma
2) suppression of autoimmune disease e.g. IBD
3) cancer (as part of chemo to reduce tumour swelling)
4) hormone replacement in adrenal insufficiency or hypopituitarism

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2
Q

What is the mechanism of action of prednisolone?

A
  • Corticosteroids UP regulate anti-inflammatory genes and DOWN regulate pro-inflammatory genes like cytokines, TNF-a
  • metabolic effect increase gluconeogenses.
  • mineralcorticoid effects —> Na+ and water retention / K+ elimination.

How they work in the cell:

  • Corticosteroids bind to cytosolic glucocorticoid receptors.
  • this then stimulates activation of glucocorticoid response elements in the nucleus.
  • this regulates gene expression.
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3
Q

What are the side effects of prednisolone?

A

1) immunosuppression
2) Metabolic effects (diabetes and osteoporosis)
3) proximal muscle weakness,
4) Skin thinning/bruising
5) gastritis
6) Mood / behaviour change = insomnia, confusion, psychosis, suicidal ideas
7) hypertension, oedema and hyperkalaemia - due to mineralcorticoid actions
8) adrenal atrophy

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4
Q

What is the side effect of prolonged corticosteroid treatment?

A
  • Adrenal atrophy
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5
Q

What is the risk of sudden withdrawal of long term corticosteroids?

A

Addisonian crisis

(malaise, fatigue, Naus/vom, abdo pain, low grade fever, muscle pain —-> dehydration —->hypotension —> hypovolaemic shock

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6
Q

When long term corticosteroids are withdrawn slowly symptoms of chronic glucocorticoid deficiency can occur - what are these symptoms?

A
  • fatigue
  • weight loss
  • athralgia
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7
Q

Who should corticosteroids be used in caution with?

A
  • infection

- children

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8
Q

What are the drug interactions of corticosteroids?

A

1) NSAIDs (combination increases risk of peptic ulcer and GI bleed —> PPI needed)
2) enhance hypokalaemia: Beta 2 agonists, theophylline, loop diuretics, thiazide diuretics

3) Efficacy of corticosteroids reduced by cytochrome P450 inducers e.g.
- phenytoin
- carbamezapine
- rifampicin

4) corticosteroids reduce immune response to vaccines

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9
Q

What drugs enhance the hypokalaemic effect of corticosteroids?

A
  • beta 2 agonist
  • loop diuretics (furosemide)
  • thiazide diuretics (bendroflumethiazide)
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10
Q

What drugs reduce the efficacy of corticosteroids?

A

Cytochrome P450 enzyme inducers:

  • Phenytoin
  • carbamezapine
  • rifampicin
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11
Q

What is the dose of prednisolone for acute asthma?

A

40 mg orally daily

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12
Q

why should once daily corticosteroid treatment be taken in the morning?

A

to mimic the natural circadian rhythm and reduce insomnia

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