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