endocrine corticosteroids

Question 1

indications for corticosteroids

Answer 1

• allergic or inflammatory disorders
• suppression of authoimmune disease
• treatment for some cancers
• hormone replacement in adrenal insufficiency or hypopituitarism

Question 2

mechanism of action of corticosteroids

Answer 2

• modify immune response
• upregulate anti inflammatory genes and downregulate pro inflammatory genes
• metabolic effects : gluconeogenesis
• mineralocorticoid effects

Question 3

mechanism of action of corticosteroids

Answer 3

• modify immune response
• upregulate anti inflammatory genes and downregulate pro inflammatory genes
• metabolic effects : gluconeogenesis
• mineralocorticoid effects

Question 4

important adverse effects corticosteroids

Answer 4

• immunosuppression
• diabetes
• osteoporosis
• mood and behaviour changes : insomnia, confusion, psychosis, suicidal ideation
• proximal muscle weakness, skin thinning, easy bruising and gastritis

Question 5

Adverse effects of corticosteroids: ATCH

Answer 5

corticosteroids suppress pituitary adrenocorticotropic hormone secretion
- this switches off normal stimulus for adrenal cortisol production
-> prolonged treatment = adrenal atrophy which prevents endogenous cortisol secretion
- if corticosteroids are withdrawn suddenly - acute addisonian crisis (with cardiovascular collapse) can occur
- slow withdrawal allows recovery of adrenal function

Question 6

symptoms of chronic glucocorticoid deficiency

Answer 6

fatigue
weight loss
arthralgia

Question 7

warnings for corticosteroids

Answer 7

• caution in patients with infection
• children : growth suppression

Question 8

corticosteroids interactions

Answer 8

• peptic ulcer risk
• gastrointestinal bleed risk
  = when used with NSAIDs
• hypokalaemia enhanced in patients taking beta agonists, theophylline, loop or thiazide like diuretics
• efficacy can be reduced by CYP450 inducers such as phenytoin, carbemazapine, rifampicin
• corticosteroids reduce immune response to vaccines

Question 9

most anti inflammatory potent steroid

Answer 9

dexamethasone

Question 10

dose of prednisolone in asthma exacerbation

Answer 10

40mg

Question 11

oral administration of corticosteroids may be inappropriate in:

Answer 11

• inflammatory bowel disease flares
• anaphylaxis
• > use IV hydrocortisone

Question 12

prescription considerations for corticosteroids long term px

Answer 12

• eg long term management : inflammatory arthritis
• use lowest effective dose
• controls disease while limiting adverse effects
• may require co prescription of steroid sparing agents e.g azathioprine, methotrexate
• bisphosphonates
• PPI

Question 13

prescription considerations for corticosteroids long term px

Answer 13

• eg long term management : inflammatory arthritis
• use lowest effective dose
• controls disease while limiting adverse effects
• may require co prescription of steroid sparing agents e.g azathioprine, methotrexate
• bisphosphonates
• PPI

Question 14

clinical tip when prescribing steroids

Answer 14

• long term corticosteroids = atrophic adrenal glands - so may be unable to increase cortisol secretion in response to stress
• provide this artificially by increasing the dose of exogenous corticosteroid
• common practice to double dose during acute illness then reduce back to maintenance on recovery