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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
Q

What are 2 GI SEs of corticosteroids?

A

Peptic ulcers

GI irritation + bleeding

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26
Q

What 4 counselling points to tell patient on steroids?

A

Take in morning- to avoid insomnia

Take with or after food - prevent GI irritation

Report psychiatric symptoms

Avoid contact with measles, chicken pox

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27
Q

What 2 CNS SEs of steroids?

A

Psychiatric reactions

Insomnia

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28
Q

What are 3 Skin related SEs of steroids?

A

Skin thinning

Purple red striae - stretch marks

Bruising

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29
Q

What are 2 eye related SEs of steroids?

A

Glaucoma

Cataracts

30
Q

What are 2 MHRA warnings about steroids?

A

Central serous chorioretinopathy

Report blurred vision + disturbances

Psychiatric reactions - stop treatment

31
Q

What is a contra-indication of steroids?

A

Avoid if patient has systemic infection & live vaccines.

Ocular infections may be exacerbated

32
Q

What is risk of abruptly stopping steroids?

A

Adrenal suppression

33
Q

What is a patient counselling point regarding preventing adrenal suppression?

A

Avoid sudden withdrawal if taking med for > 3 weeks.

NHS patient safety alert + card.

34
Q

What are sick day rules surrounding steroids?

A

In fever, take high dose.

If vomiting - take extra dose.

35
Q

What is a pneumonic for SEs of steroids?

A

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
Q

How to manage taking corticosteroid to avoid SEs? (5)

A

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
Q

What pateints should AVOID abrupt withdrawal of steroids? (5)

A

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
Q

What 3 drugs can increase steroid level?

A

Clarithromycin

Itraconazole

Ketaconazole

39
Q

What 3 drugs decrease steroid levels?

A

Carbamazepine

phenytoin

rifampicin

40
Q

What drug class can increase GI bleed risk with steroid?

A

NSAIDs

41
Q

What drug classes can increase risk of hypokalaemia with steroid use?

A

B2 agonist, loop + thiazide diuretic, theophylline

TCA, macrolides, SSRIs, Antipsychotics

42
Q

What are 2 MHRA warnings about hydrocortisone?

A

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
Q

What solution for alkindi (hydrocortisone) tablet to granule switch in children?

A

observe for symptoms in 1st week + take action- increase dose

44
Q

What are 2 MHRA warnings about methylprednisolone?

A

Injectable me has lactose- not to use in allergic patients

Lactose free- serious allergic reactions if confusing formulations

45
Q

What is adrenal insufficiency?

A

adrenal glands do not make enough cortisol + aldosterone

46
Q

What are 2 treatment drugs for adrenal insufficiency?

A

Hydrocortisone

Fludrocortisone

47
Q

How many doses of hydrocortisone is given in adrenal insufficiency?

A

2 doses

48
Q

What formuation to give in adrenal crisis?

A

IV version of HC or Fludrocortisone

49
Q

What are some symptoms of adrenal crisis?

A

Low BP, dizzy, fever, shivering, N, V +D, tiredness, drowsiness or confusion, aching muscles + joints, stomach ache

50
Q

What are sick day rules for using steroids during fever or infection and requiring antibiotics?

A

2 times daily use

Switch to short acting

51
Q

What are 2 short acting steroids?

A

Hydrocortisone

Cortisone

52
Q

What steroid to use if persistent vomiting from GI viral illness?

A

Using IV or IM steroid

53
Q

What is important to note in sick day rules in steroid patients?

A

Carry emergency kit

54
Q

What is cushing’s syndrome?

A

Set of symptoms caused by high cortisol levels

55
Q

What are 6 symptoms of cushing’s syndrome?

A

Hiruitism

Erectile dysfunction

obesity

osteoporosis

purple striae

hypertension

Moon face

56
Q

What is 1st line drug tx for cushing’s syndrome?

A

Ketoconazole

57
Q

What are 2 counselling points on ketaconazole for cushing’s syndrome?

A

Report signs of liver disorder

Report signs of adrenal insufficiency

58
Q

What 3 electrolyte imbalances in adrenal insufficiency?

A

HypOnatraemia

HypERkalaemia

HypOglycaemia

59
Q

What are 3 Mineralocorticoid SEs?

A

HTN

Hypokalaemia

Hypocalcaemia

60
Q

What are 4 glucocorticoid SEs?

A

Diabetes

osteoporosis

necrosis of femoral head + muscle wasting

GI ulceration + perforation

61
Q

What 2 conditions to avoid when on steroids?

A

Measles and chickenpox

62
Q

What happens if person taking steroids has chickenpox?

A

Urgent treatment needed

63
Q

What to do if patient on steroids has measles

A

Prophylaxis of IM immunoglobulin

Seek medical advice

64
Q

What is a mild steroid?

A

Hydrocortisone

65
Q

What is a MODERATE steroid?

A

Clobethasone

66
Q

What is a potent steroid?

A

Betamethasone

67
Q

What is a very potent steroid?

A

Clobetasol

68
Q

What are 5 Mineralocorticoid effects?

A

hypertension
sodium retention
water retention
potassium loss
calcium loss

69
Q

What are 6 glucocorticoid effects?

A

Diabetes

Osteoporosis

high doses are associated with avascular necrosis of the femoral head

muscle wasting (proximal myopathy)

Peptic ulceration and perforation

psychiatric reactions

70
Q

What are some SEs of abrupt withdrawal of steroids?

A

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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