Corticosteroids (tablets) Flashcards
1
Q
What are the generic and brand names of corticosteroid tablets?
A
- Prednisolone (Pred Forte)
- Dexamethasone
- Betamethasone
- Hydrocortisone
- Budesonide
2
Q
What is the method of action of tablet corticosteroids?
A
- Bind to cytosolic glucocorticoid receptors
- Translocation to the nucleus and binding to glucocorticoid response elements = regulate gene expression
- Upregulate anti-inflammatory genes and downregulate pro-inflammatory genes
- Supresses circulating monocytes/eosinophils
- ↑ gluconeogenesis from amino acids and fatty acids
- Mineralocorticoid effect = stimulate Na+ and water retention and K+ excretion in the renal tubules
3
Q
What are the indications for tablet corticosteroids?
A
- To treat allergic/inflammatory disorders e.g.
- asthma
- Suppression of autoimmune diseases e.g. IBD
- Treatment of cancers as part of chemotherapy/reduce tumour associated swelling
- Hormone replacement in adrenal insufficiency/hypopituitarism
4
Q
What are the contraindications for corticosteroid tablets?
A
- Already have an infection
* Children – supresses growth
5
Q
What are the side effects of corticosteroid tablets?
A
- ↑ risk and severity of acquiring infections
- Diabetes
- Osteoporosis
- Proximal muscle weakness
- Skin thinning
- Easy bruising
- Gastritis
- Insomnia
- Confusion
- Psychosis
- Suicidal ideas
- Hypertension
- Hypokalaemia
- Oedema
- Adrenal atrophy = Addisonian crisis with CV collapse
6
Q
What are the interactions with corticosteroid tablets?
A
- NSAIDs - ↑ risk of peptic ulcers/GI bleeding
- Beta 2 agonists - ↑ hypokalaemia
- Theophylline - ↑ hypokalaemia
- Loop diuretic - ↑ hypokalaemia
- Thiazide diuretic - ↑ hypokalaemia
- Vaccines – steroids reduce immune response
- Cytochrome P450 inducers e.g. phenytoin, carbamazepine – efficacy ↓
7
Q
What organ eliminates corticosteroid tablets?
A
Liver
8
Q
What information should the patient be told before taking corticosteroid tablets?
A
- Should start to feel a difference in 1-2 days
* Do not stop the medication suddenly
