CS Flashcards
PO CS - what do they do? (MOA and effects on immune sys)
inhibit NFkB which is pro inflammatory transcription factor
T cell apoptose
B cell reduce Ig production
Eos - reduce # /function
mast cells - degranulation inhibited
LCH decrease APC
fibroblasts - decrease collagen production
IM CS - s/e (unique)
IV Cs - s/e
IM: cold abscesses, lipoatrophy, crystallization, mentrual irreg
IV - lyte abn (minerocorticoid Na + /K +, cardiac arrhythmias inlc AFIB
7 deadly s/e of CS?
peptic ulcer
GI perf - reduces mucosal coating and wound healing
DKA - hyperglycemia
opportunistic infections /malignancy (down regulates T cells and B cells)
ADRENAL crisis
HTN -> MI
CHF 2’ Na+ retention
CS - 2 short, 2 mid 2 long acting? physiologic dose?
cortisone, cortisol
prednisolone, prednisone
methylpred/bexamethasone (least mineralocorticoid)
5-7.5 mg
CS doses pulsed/IV? IM
IM 80 Q3-4 months
pulsed 500 -1000 mg of methylpred IV for up to 3-5 days over 60 minutes, need cardiac/lyte monitoring
ASK before starting oral steroids?
hyperglycaemia, hyperthyroid/hypothyroid - dose adjustment active infectious active GI dz esp PUD pregnancy/lactation adrenal problems bone mineral density problems, pathologic fractures serious mood disorders cataracts
steroids orally - what lab and other investigations to monitor before start?
Vitals - BP, HR, kids growth (b/c stunts GH) CHEMIst GOes Cancers - nothing Heme - CBC before start Endo - HbA1C, fasting lipids help MSK - bone mineral density of long course preorder Infectious - CXR, Hep B/C, HIV GI - nil Ocular - optho check helps PREGGO!
ALSO POTASSIUM
steroid start - what prophylaxis is needed ?
VACCINES inlc covid Vit D 800 U Ca 1200 U long term PPI like famotidine 40 OD Septra DS 3 times a week Optho check before start
labs of pred ?
INFECTIOUS SCREEN : TB, HEP B?C, HIV!!!!!
CBC, lytes (K!!) fasting triglycerides, renal, hepatic, HbA1C/FBG
AT 1 months and then Q3 months
EXAM BP, HR, WEIGHT, GROWTH IN KIDS
OPTHO Q6 months - CATARACTS< GLAUCOMA
how do you stress dose pred before surgery
hydrocortisone 100 mg night before, peri-op, 8 hrs later then decrease by 50% each day until physiologic dose
reminder HC 20 = 5 of pred so 100 = 25 of pred
AA - what are some pulse regiments and what side effects do they NOT avoid
pulsed: does not avoid cataracts and bone effects like osteoporosis, necrosis
300 prednisolone Q1 month
some methylpred 500-100o Q1 months
dex/beta 5-10 mg 2/7 (weekly) (5 of pred = 0.75 of dex, so about 60 mg of pred BIW)
5 meds to avoid w/ pred
WE PANIC with CS: Warfarin ASA, NSAIDS INSULIN CsA, other immunosupreessants
steroid PO s/e?
CHEMISt GO (urticaria chemist all about pred 100)
Cancers - opportunistic
CHF, edema
Heme - lymphocytosis
Endo - hyperlipidemia, hyperglycemia, minerocorticoid changes including Na/K imbalance
MSK - myopathy, osteonecrosis avascular, bone mineral density changes
MOOD - decreased, irritability, europhia, insomnia, reliance
Infectious - 2’, prolonged, blunted vaccine response
Skin - delayed wound healing, skin thinning, striae, moon facies, buffalo hump, peripheral edema,
GI - risk of ulcer, perforation, PUD, IBD
Ocular - cataracts, glaucoma
c/i to CS use?
hypersensitivity, concurrent administration of live or live-attenuated vaccines (when using immunosuppressive dosages), systemic fungal infection, osteoporosis, uncontrolled hyperglycemia, diabetes mellitus, glaucoma, joint infection, uncontrolled hypertension, herpes simplex keratitis, and varicella infection
Additional relative contraindications include peptic ulcer disease, congestive heart failure, and viral or bacterial infections not controlled by anti-infectives.
