Glucocorticoid therapy Flashcards
(glucocorticoids/mineralocorticoids) have anti-inflammatory and immunosuppressant effects?
Glucocorticoids
(glucocorticoids/mineralocorticoids) regulate renal sodium and water reabsorption and potassium excretion
Mineralocorticoids
Fludrocortisone acetate has high (glucocorticoid/mineralocorticoid) activity
Mineralocorticoid
Why is hydrocortisone unsuitable for disease suppression on a long term basis?
Fluid retention (due to relatively high mineralocorticoid activity)
Exception: adrenal replacement therapy in Adrenal insufficiency
Prednisolone has predominantly (glucocorticoid/mineralocorticoid) activity with minimal (glucocorticoid/mineralocorticoid) effects
- Glucocorticoid
- Mineralocorticoid
Prednisolone is the corticosteroid most commonly used by mouth for long-term disease suppression
Betamethasone and dexamethasone have very high (glucocorticoid/mineralocorticoid) activity in conjunction with insignificant (glucocorticoid/mineralocorticoid) activity.
- Glucocorticoid
- Mineralocorticoid
This makes them particularly suitable for high-dose therapy in conditions where fluid retention would be a disadvantage
Some esters of betamethasone and beclomethasone exert a considerably more marked (oral/topical) effect than when given (orally/topically)
- Topical
- Orally
Use is made of this to obtain topical effects whilst minimising systemic side-effects
Deflazacort has high (glucocorticoid/mineralocorticoid) activity
Glucocorticoid
It is derived from prednisolone
What are the indications for the use of beclometasone dipropionate? (5)
- Management of oral ulceration
- Prophylaxis of asthma
- Prophylaxis and treatment of allergic and vasomotor rhinitis
- Severe inflammatory skin disorders (eczamas unresponsive to less potent corticosteroids, psoriasis)
- Adjunct to aminosalicylates in acute mild to moderate ulcerative colitis
What are the contraindications for all systemic corticosteroids? (3)
- Avoid injections containing benzyl alcohol in neonates
- Avoid live virus vaccines in those receiving immunosuppressive doses (serum antibody response diminished)
- Systemic infection
What are the contraindications for all topical corticosteroids? (5)
- Acne
- Perioral dermatitis
- Potent corticosteroids in widespread plaque psoriasis
- Rosacea
- Untreated bacterial, fungal or viral skin lesions
When are systemic corticosteroids prescribed to the elderly potentially inappropriate (STOPP criteria)?
- If used instead of inhaled corticosteroids for maintenance therapy in moderate to severe COPD
- As long-term (>3 months) monotherapy for rheumatoid arthritis
- For treatment of osteoarthritis other than for periodic intra-articular injections for monoarticular pain
- With concurrent NSAIDs without PPI prophylaxis
What are the common side effects for inhaled corticosteroids?
- Headache
- Oral candidiasis
- Pneumonia (in patients with COPD)
- Taste altered
- Voice alteration
What can be used with a corticosteroid inhaler to reduce the risk of oral candidiasis? (2)
- Spacer device
2. Rinsing mouth with water after inhalation of a dose
If a patient using an inhaled corticosteroid get oral candidiasis and is treated with an anti-fungal oral suspension or oral gel, do they need to stop the corticosteroid therapy?
NO
An anti-fungal oral suspension or oral gel can be used to treat oral candidiasis without discontinuing corticosteroid therapy.
Paradoxical (?) is an uncommon side effect of inhaled corticosteroids
bronchospasm
What can be used to prevent mild paradoxical bronchospasm in a patient taking inhaled corticosteroids?
Short-acting beta-2 agonist inhaler before the corticosteroid
Moderate to severe paradoxical bronchospasm requires discontinuation and alternative therapy
What are the common side effects of intranasal corticosteroids? (6)
- Altered smell sensation
- Epistaxis
- Headache
- Nasal complaints
- Taste altered
- Throat irritation
What is a rare but serious uncommon side effect of intranasal corticosteroids?
Glaucoma
What are the common side effects of topical corticosteroids?
- Skin reactions
2. Telangiectasia
Do inhaled corticosteroids for asthma need o be stopped during pregnancy?
NO
Take as normal during pregnancy
Should systemic corticosteroids be stopped during pregnancy?
Not usually
The benefit of treatment with corticosteroids during pregnancy outweighs the risk
Corticosteroid cover is required during labour
What needs to be monitored in pregnant women taking systemic corticosteroids?
Fluid retention
Do intranasal and systemic corticosteroids need to be stopped during breastfeeding?
NO
Benefits outweigh risks
What needs to be monitored in children taking inhaled and systemic corticosteroids for a prolonged period? (2)
Height
Weight
What needs to be monitored in children taking intranasal corticosteroids for a prolonged period? (1)
Height
What are the indications for the use of betamethasone?
- Local treatment of inflammation (short-term)
- Severe inflammatory skin disorders (eczema, psoriasis)
- Suppression of inflammatory and allergic disorders
- Congenital adrenal hyperplasia
- Oral ulceration
What are the indications for the use of deflazacort?
- Suppression of inflammatory and allergic disorders (oral(
- Maintenance 3-18 mg daily
- Acute: up to 120 mg daily - Inflammatory and allergic disorders in children
- Oral
Dexamethasone has very high (glucocorticoid/mineralocorticoid) activity and insignificant (glucocorticoid/mineralocorticoid) activity
- Glucocorticoid
2. Mineralocorticoid
In addition to the contraindications for all corticosteroids, what are the additional contraindications for the use of intravitreal dexamethasone? (5)
- Active ocular herpes simplex
- Active or suspected ocular infection
- Active or suspected periocular infection
- Rupture of the posterior lens capsule in patients with aphakia, iris or transscleral fixated intra-ocular lens or anterior chamber intra-ocular lens
- Uncontrolled advanced glaucoma
With intravitreal use of dexamethasone in adults, administration of which two drug classes requires caution?
Anticoagulants
Antiplatelets
Due to increased risk of haemorrhagic events
Why do you need caution when prescribing intravitreal dexamethasone in patients taking anticoagulants or antiplatelet drugs?
Increased risk of haemorrhagic events
What needs to be monitored in patients using intravitreal dexamethasone? (3)
- Intra-ocular pressure
- Signs of ocular infection
- In patients with posterior capsule tear or iris defect - monitor for implant migration
What are the indications for the use of fludrocortisone?
- Neuropathic postural hypotension
- Mineralocorticoid replacement in adrenocortical insufficiency
- Adrenocortical insufficiency resulting from septic shock (in combination with hydrocortisone)
Hydrocortisone has (equal/unequal) glucocorticoid and mineralocorticoid activty
Equal
What needs to be monitored in patients with systemic sclerosis taking systemic prednisolone?
- BP
- Renal function (s-creatinine)
Increased incidence of scleroderma renal crisis
What is the risk of using systemic prednisolone in patients with systemic sclerosis?
Increased incidence of scleroderma renal crisis
As prednisolone crosses the placenta 88% of prednisolone is (?)
inactivated
Prednisolone appears in small amounts in breast milk but maternal doses of up to (?) mg daily are unlikely to cause systemic effects in the infant
40 mg
If a breastfeeding mother is taking more than 40 mg daily of prednisolone, what needs to be monitored for in the infant?
Adrenal suppression
