Glucocorticoids Flashcards
What are glucocorticoids?
Corticosteroids with potent anti-inflammatory, immunosuppressive and metabolic effects.
High glucocorticoid activity = anti-inflammatory
Dexamethasone/betamethasone
- Most potent
- Long duration of action
- Very high glucocorticoid activity
- Very little mineralocorticoid activity
- Used if fluid retention is a disadvantage e.g. HF
- Suitable for high dose therapy
Prednisolone/prednisone
Significant activity
Long-term disease suppression
Prednisolone = most common steroid used by mouth
Used in acute or severe chronic asthma, COPD, IBD
Deflazacort
Deflazacort is derived from prednisolone.
High glucocorticoid activity
Side effects
ME A PIG
Endocrine
Musculoskeletal
GI
Psychiatric
Infections
Adrenal suppression
Side effects - other
Opthalmic
Skin
CNS
Growth restriction
Endocrine
Diabetes
Musculoskeletal
Osteoporosis
- High corticosteroid doses = avascular necrosis of femoral head
- Prophylaxis with bisphosphonates = >3 months use
Muscle wasting
- Proximal myopathy
- CAUTION with statins
GI
Peptic ulcers
GI irritation
Dyspepsia
Counselling = take with or after food
Psychiatric reactions
Paranoid OR depression with suicide risk
Can occur whilst taking or on withdrawal
- Euphoria
- Irritable
- Insomia/nightmares
Counsel pt to report and seek help
Infections
Immunosuppression = increased susceptibility and severity of infections.
Atypical clinical presentation
Serious infections not detected until advanced stage
Avoid closed contact with chickenpox or shingles
Avoid exposure to measles
Avoid close contact with chickenpox or shingles
- Exposed non immune patients need passive immunisation with varicella-zoster immunoglobulin
- Applies to patients currently taking or stopped <3 months.
- If chickenpox develops, need urgent specialist treatment
Avoid exposure to measles
If exposed, seek immediate medical advice
Prophylaxis with normal immunoglobulin may be required
Adrenal suppression
Can occur up to 1 year after stopping
- Fatigue
- Anorexia
- Nausea
- Vomiting
- Hyponatraemia
- Hypotension
- Hyperkalaemia
- Hypoglycaemia
IMPORTANT
Patients must mention if they are taking steroids or have stopped in <1 year during any treatment for illness or injury.
Anaesthesia = dangerous fall in BP
Need adrenal replacmeent with IV hydrocortisone
Abrupt withdrawal
Avoid abrupt withdrawal if use >3 weeks
- Acute adrenal insufficiency
- Hypotension
- Death
Opthalmic
MHRA: Corticosteroids; rare risk of central serious chorioretinopathy with local and systemic use.
Glaucoma
Cataracts
Counsel patients to report:
- blurred vision
- visual disturbances
Skin
Skin thinning
Purple-red striae
Bruising
CNS
Aggravated
Epilepsy
Schizophrenia
Growth restriction
Occurs in children
High doses
Cushing’s syndrome
SE - Summary
ACHING BOSOM
Adrenal suppression, appetite larger, abrupt withdrawal reactions
Cushing syndrome, cataracts
Hyperglycaemia (diabetes), hyperlipidaemia
Infections, insomnia
Nervous system
Glaucoma, GI ulcers
BP increase
Osteoporosis
Skin thinning
Obesity
Muscle wasting
MHRA advice
Methylprednisolone injectable medicine contains lactose; do not use in patients with cows milk allergy, Serious allergic reactions including bronchospasm and anaphylaxis reported in patients with cows milk allergy. If symptoms worsen or new allergic symptoms, stop and treat.
Counselling points
Risk of infections
Adrenal suppression
Psychiatric reactions
Withdrawal of corticosteroids
How to manage side effects
Lowest effective dose for minimum period.
Local treatment preferred over systemic.
Single dose in the morning - suppressive action on cortisol secretion is least in the morning.
Alternate day administration
- Take two days as a single dose to further reduce suppression
Short courses intermittently
Avoid abrupt withdrawal
- Long term use ( >3 weeks)
- > 40 mg prednisolone daily or equivalent for more than 1 week.
- Repeat doses in evening (BD dosing)
- Recent repeated courses
- Short course within 1 year of stopping long-term steroids
- Have other causes of adrenal suppression
Steroid card
Issue to patients taking long-term corticosteroid for 3+ weeks
Consider issuing to patients using greater than maximum licensed doses of inhaled corticosteroids
Pregnancy + BF
Generally safe
Monitor for fluid retention in pregnant woman
