Exogenous Steroids

Question 1

what is the most common use of corticosteroids?

Answer 1

anti-inflammatory adn immunosuppressive drug

Question 2

what is a rare use of corticosteroids?

Answer 2

as a replacement therapy for adreno-cortical insufficiency

Question 3

how can corticosteroids be administered?

Answer 3

orally
systemically
topically

Question 4

how are cortisone and prednisone activated?

Answer 4

by the liver

Question 5

true or false - systemic effects can also occur with topical administration?

Answer 5

true

Question 6

what are examples of topical administration of corticosteroids (5)?

Answer 6

Injected intra-articularly

Rectally as enemas

As aerosol into the respiratory tract

As drops into the eye or the nose

As creams and ointments to the skin.

Question 7

when are unwanted effects of pharmacological use of corticosteroids caused?

Answer 7

most likely to occur with large doses and prolonged administration

Question 8

what are the side effects of corticosteroids associated with?

Answer 8

Metabolic effects leading to iatrogenic Cushing’s syndrome

Infection or injury suppression

HPA suppression

Question 9

why are steroid treated patients more susceptible to infections?

Answer 9

due to the anti-inflammatory and immunosuppressant activity of steroids.

Question 10

what influences the degree of HPA suppression (6)?

Answer 10

Dose
Dosing interval
Time of administration
Length of administration 
Route of administration
Patient variability

Question 11

what approaches are taken to minimise HPA suppression (6)?

Answer 11

Use the lowest possible dose
Local treatment whenever possible
Use drugs with shorter half-life
Give as a single morning dose
Use alternate-day therapy 
May be possible to reduce dose by adding a small dose of immunosuppressive agents

Question 12

when can you easily discontinue glucocorticoid treatment?

Answer 12

Short-term, low-dose glucocorticoid treatment of up to about 3 weeks can usually be discontinued abruptly.

Question 13

what is an example of short-term, low-dose glucocorticoid treatment?

Answer 13

prednisone <20 mg/day or equivalent

Question 14

why is it harder to discontinue chronic glucocorticoid treatment?

Answer 14

can cause exacerbation of the underlying disease with or without steroid withdrawal syndrome.

Question 15

how is steroid withdrawal syndrome manifested?

Answer 15

fatigue, weakness, arthralgia, nausea, hypotension and dizziness