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PRE-REG-Thuri > ENDOCRINE- CORTICOSTEROIDS + CONDITIONS > Flashcards

ENDOCRINE- CORTICOSTEROIDS + CONDITIONS Flashcards

1
Q

What is MOA of corticosteroids?

A

Synthetic version of hormones made by adrenal gland.

e.g. aldosterone , cortisol

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2
Q

What is aldosterone?

A

mineralocorticoid

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3
Q

What is cortisol?

A

Glucocorticoid

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4
Q

What is use of corticosteroids?

A

Inflammation + as an immunosuppressant

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5
Q

What are 2 routes of corticosteroids

A

Systemic e.g. oral

Local e.g. inhaled, topical + rectal

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6
Q

List 8 corticosteroids?

A

Betamethasone

Deflazacort

Dexamethasone

Fludrocortisone

Hydrocortisone

Methylprednisolone

Prednisolone

Triamcinolone

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7
Q

What 4 conditions are prednisolone used for?

A

Atsthma

COPD

Excema

IBD

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8
Q

What is dexamethasone usually used in?

A

Palliative care, anorexia

raised intracranial pressure

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9
Q

What is fludrocortisone used for?

A

Replacement therapy of aldosterone

mineralocorticoid

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10
Q

What is hydrocortisone?

A

replacement of cortisol

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11
Q

What are the 2 mineralocorticoid effects on electrolytes?

A

Na+/fluid retention = HTN + oedema caused

K+ excreted = HypOkalaemia + hypERcalcaemia

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12
Q

What is the most potent mineralocorticoid?

A

Fludrocortisone

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13
Q

What are 2 indications of
Fludrocortisone?

A

Neuropathic postural hypotension

Septic shock

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14
Q

What is hydrocortisone used in?

A

Acute hypersensitivity

Adrenal insufficiency

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15
Q

What are glucocorticoid effects?

A

Anti-inflammatory , low fluid retention

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16
Q

What 2 drugs are the most potent glucocorticoids?

A

dexamethasone

Betamethasone

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17
Q

What steroid has Significant mineralocorticoid activity?

A

Hydrocortisone

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18
Q

What 2 drugs are prednisolone derivatives?

A

Methylprednisolone

Deflazacort

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19
Q

What is a main SE of corticosteroid?

A

obesity

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20
Q

What are 3 endocrine SE of corticosteroids?

A
  1. Diabetes
  2. Cushing’s syndrome
  3. Growth failure in children
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21
Q

What 2 things to monitor children on steroids?

A

Height + Weight

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22
Q

What are 2 musculoskeletal SEs of corticosteroids?

A

Muscle wasting

Osteoporosis

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23
Q

What to give patients to prevent osteoporosis?

A

Bisphosphonates

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24
Q

What are 2 cautions in muscle wasting due to steroids?

A

Caution in patients on statins

Caution - myasthenia gravis

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25
What are 2 GI SEs of corticosteroids?
Peptic ulcers GI irritation + bleeding
26
What 4 counselling points to tell patient on steroids?
Take in morning- to avoid insomnia Take with or after food - prevent GI irritation Report psychiatric symptoms Avoid contact with measles, chicken pox
27
What 2 CNS SEs of steroids?
Psychiatric reactions Insomnia
28
What are 3 Skin related SEs of steroids?
Skin thinning Purple red striae - stretch marks Bruising
29
What are 2 eye related SEs of steroids?
Glaucoma Cataracts
30
What are 2 MHRA warnings about steroids?
Central serous chorioretinopathy Report blurred vision + disturbances Psychiatric reactions - stop treatment
31
What is a contra-indication of steroids?
Avoid if patient has systemic infection & live vaccines. Ocular infections may be exacerbated
32
What is risk of abruptly stopping steroids?
Adrenal suppression
33
What is a patient counselling point regarding preventing adrenal suppression?
Avoid sudden withdrawal if taking med for > 3 weeks. NHS patient safety alert + card.
34
What are sick day rules surrounding steroids?
In fever, take high dose. If vomiting - take extra dose.
35
What is a pneumonic for SEs of steroids?
ACHING BOSOM Adrenal suppression Cushing syndrome (cataract) Hyperglycaemia, hyperlipidaemia Infections, insomnia Nervous system - psychiatric reaction Glaucoma, GI ulcer BP rasied, hypokalaemia Osteopororis Skin thinning Obesity Muscle wasting
36
How to manage taking corticosteroid to avoid SEs? (5)
Lowest effective dose for minimum period single dose- morning administer total dose of 2 days as single dose on alternative days intermittent short courses local route- inhaled
37
What pateints should AVOID abrupt withdrawal of steroids? (5)
Repeat dose in evening Repeated courses taking short course within 1 year stopping > 40mg daily for 1+ week those using >3 weeks Other causes of adrenal suppression
38
What 3 drugs can increase steroid level?
Clarithromycin Itraconazole Ketaconazole
39
What 3 drugs decrease steroid levels?
Carbamazepine phenytoin rifampicin
40
What drug class can increase GI bleed risk with steroid?
NSAIDs
41
What drug classes can increase risk of hypokalaemia with steroid use?
B2 agonist, loop + thiazide diuretic, theophylline TCA, macrolides, SSRIs, Antipsychotics
42
What are 2 MHRA warnings about hydrocortisone?
Muco-adhesive buccal tablets should NOT be used off-label in children for adrenal insufficiency Alkindi - acute adrenal insufficiency in children switching tab to granules
43
What solution for alkindi (hydrocortisone) tablet to granule switch in children?
observe for symptoms in 1st week + take action- increase dose
44
What are 2 MHRA warnings about methylprednisolone?
Injectable me has lactose- not to use in allergic patients Lactose free- serious allergic reactions if confusing formulations
45
What is adrenal insufficiency?
adrenal glands do not make enough cortisol + aldosterone
46
What are 2 treatment drugs for adrenal insufficiency?
Hydrocortisone Fludrocortisone
47
How many doses of hydrocortisone is given in adrenal insufficiency?
2 doses
48
What formuation to give in adrenal crisis?
IV version of HC or Fludrocortisone
49
What are some symptoms of adrenal crisis?
Low BP, dizzy, fever, shivering, N, V +D, tiredness, drowsiness or confusion, aching muscles + joints, stomach ache
50
What are sick day rules for using steroids during fever or infection and requiring antibiotics?
2 times daily use Switch to short acting
51
What are 2 short acting steroids?
Hydrocortisone Cortisone
52
What steroid to use if persistent vomiting from GI viral illness?
Using IV or IM steroid
53
What is important to note in sick day rules in steroid patients?
Carry emergency kit
54
What is cushing's syndrome?
Set of symptoms caused by high cortisol levels
55
What are 6 symptoms of cushing's syndrome?
Hiruitism Erectile dysfunction obesity osteoporosis purple striae hypertension Moon face
56
What is 1st line drug tx for cushing's syndrome?
Ketoconazole
57
What are 2 counselling points on ketaconazole for cushing's syndrome?
Report signs of liver disorder Report signs of adrenal insufficiency
58
What 3 electrolyte imbalances in adrenal insufficiency?
HypOnatraemia HypERkalaemia HypOglycaemia
59
What are 3 Mineralocorticoid SEs?
HTN Hypokalaemia Hypocalcaemia
60
What are 4 glucocorticoid SEs?
Diabetes osteoporosis necrosis of femoral head + muscle wasting GI ulceration + perforation
61
What 2 conditions to avoid when on steroids?
Measles and chickenpox
62
What happens if person taking steroids has chickenpox?
Urgent treatment needed
63
What to do if patient on steroids has measles
Prophylaxis of IM immunoglobulin Seek medical advice
64
What is a mild steroid?
Hydrocortisone
65
What is a MODERATE steroid?
Clobethasone
66
What is a potent steroid?
Betamethasone
67
What is a very potent steroid?
Clobetasol
68
What are 5 Mineralocorticoid effects?
hypertension sodium retention water retention potassium loss calcium loss
69
What are 6 glucocorticoid effects?
Diabetes Osteoporosis high doses are associated with avascular necrosis of the femoral head muscle wasting (proximal myopathy) Peptic ulceration and perforation psychiatric reactions
70
What are some SEs of abrupt withdrawal of steroids?
lead to acute adrenal insufficiency, hypotension or death. Withdrawal can also be associated with fever, myalgia, arthralgia, rhinitis, conjunctivitis, painful itchy skin nodules and weight loss.

PRE-REG-Thuri (44 decks)

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