Endocrine: Steroid conditions Flashcards
If high glucocorticoid activity - what are the effects?
Most anti-inflammatory effects
Dex, Beta, Pred, deflazacort
If high mineralocorticoid activity - what are the effects? Give drug examples
fluid retention - Sodium and water retention (Hypertension) and K+ and Ca loss
fludrocortisone, hydrocortisone (but not as much) , corticotrophin
Which steroid has highest mineralocorticoid activity?
Fludrocortisone
What are the highest potency glucocorticoids? but what is most commonly used?
Dexamethasone
Betamethasone
Most common is prednisolone (significant potency)
What is the adrenal replacement therapy for addisons disease? How are these given?
Hydrocortisone and fludrocortisone
Hydrocortisone is given in 2 doses - larger in morning and smaller in evening to mimix natural cortisol secretion
What is the replacement for hypopituitism?
Where the pituitary gland does not stimulate hormone secretion - only need to replace with Hydrocortisone (not fludro because RAAS regulates aldosterone)
Reeplace sex hormones and thyroid too e.g. levo
What is a NHS improvement patient safety alert for steroids?
Steroid emergency card to support early recognition and treatment of adrenal crisis
What is the treatment for acute adrenal crisis
IV hydrocortisone - rapid acting
What is the acronym to remember glucocorticoid (corticosteroid) side effects?
ACHING BOSOM
IDENTIFY corticosteroid S/E using the acronym aching bosom
A:adrenal suppression, abrupt withdrawal rxn, apetite C: cushing syndrome, cataracts H: hyperglycaemia, hyperlipidaemia I: infections, insomnia N: nervous system,psychiatric reactions G:glaucoma, GI ulcer
B: blood pressure increase (HTN) O: osteoporosis S: skin thinning O:obesity M:muscle wasting
What are the effects of glucocorticoids on musculoskeletal?
Osteoporosis
Avascular necrosis of femoral head
Fracture risk
If using corticosteroids for?3 months what is used as prophylaxis for osteoporosis?
Bisphosphonates
What are the GI effects of corticosteroids and counselling?
Peptic/GI ulcers and dyspepsia
Take with food
What is the psychiatric risk of corticosteroids?
Paranoia or depression - report
What is the risk of infection when patients taking corticosteroids?
Immunosuppression- increased infection but atypical presentations e.g. not detected until advanced stages e.g. TB/septicaemia, amoebiasis, may not present with typical rash in chickenpox/shingles etc
What is the advice to patients regarding chickenpox in corticosteroid use and for 3 months after?
Avoid exposure /close contact
If a patient is non-immune to chickenpox and needs CCS, what is done?
Passive immunisation with varicella zoster immnunoglobulin
What is advice regarding vaccinations for patients on CCS
Avoid live vaccines e.g. influenza, MMR, BCG, Varicella, yellow fever
What are the symptoms of adrenal suppression and when can they occur
1 year after stopping
fatigue, anorexia, nausea, vomiting, SEVERE HYPOTENSION
Hyperkalaemia, Hyponatraemia
During stress/trauma/illness, what changes are needed to steroids and why?
During stress etc cortisol levels rise but this doesn’t occur in people on steroids due to adrenal suppression - so because there is diminished adrenal cortex action- need to increase doses of steroids
What is the MHRA warning for steroids regarding eyes?
Chorioretinopathy - local and systemic - blurred vision and visual disturbances
With high doses of steroids what can occur? what are symptoms?
Cushing syndrome - moon face, striae, acne, hirutism - usually reversible - need to tape down the steroid to withdraw
As per MHRA warning, what steroid injection should not be used in patientss with a cows milk allergy?
Methylprednisolone injection (solu-medrone 40mg) - contains lactose
What situations would you avoid abrupt withdrawal of steroids?
Long term >3weeks >40mg pred daily or equivalent Repeat doses in evening addisons short course within 1 year of stopping long term recent repeated courses
