Issues with steroid usage Flashcards
What impacts the choice of steroid used?
Different steroids have different mineralocorticoid ans gluticorticoid potency.
What are steroid used for?
Their anti-inflammatory and immunosuppressive properties
What are some examples of conditions treated by steroids?
- Asthma
- IBS
- Arthiritis
- Eczema
- Allergies
What are the local adverse effects associated with steroid use?
- Topical formulations- Skin thinning, skin infections, Folliculitis (inflamed hair follicles), stretch marks, acne
council patients to use creams sparingly - Inhaled formulations- Hoarseness, throat infection, dysphonia, oral thrush (Encourage use of spacer, wash mouth out and teeth after use)
What are the systemic adverse effects associated with steroid use?
Adrenal suppression- longterm use of artificial steroids cause a lack in production of endogenous steroids. Therefore, abrupt withdrawal of steroids will result in acute adrenal insufficiency as adrenal glands cant suddenly resume producing endogenous steroids.
- increases severity and susceptibility to infection
- Psychiatric reactions e.g. euphoria, nightmares, insomnia
Why cant steroids be stopped abruptly?
Longterm use of artificial steroids cause a lack in production of endogenous steroids.
Abrupt withdrawal of steroids will result in acute adrenal insufficiency as adrenal glands cant suddenly resume producing endogenous steroids.
What are the potential consequences of abrupt withdrawal from steroids?
hypotension
confusion
coma
death if untreated
What is the important point about stress and steroids?
With artificial steroids, the body cant respond to stress or illness. Normally, endogenous steroid production is increased as a response tp stress
What is the procedure for steroid usage in periods of stress?
During periods of stress e.g. incurrent illness, surgery or trauma, a patient is advised to follow ‘sick day rules’ which recommend the individuals steroid dosage to be doubled to compensate.
What must all patients carry if they’re on steroids?
A blue card containing details of their steroid treatment
In what circumstances must steroid withdrawal be gradual?
- If taking > 40mg a day for greater than 1 week
- If taking treatment for longer than 3 weeks
- If recently received repeated courses of steroids- accumulative dosage
- had a short course within 1 year of stopping longterm therapy
What dosage can steroids be reduced to before being a gradual reduction?
- Physiological steroid levels- 7.5 mg per day
Will then decrease slowly
What is the effect of steroids on infections?
- Prolonged steroid use can increase susceptibility and severity of infections due to their immunosuppressive activity
- Patient on steroids may have atypical presentation of symptoms and can get to a late stage of infection without being identified
Who must people on steroids avoid and the action should they come into contact?
- People with chicken pox (Especially if haven’t had themselves), measles or shingles
- if they are exposed, they should seek medical attention immediately as this can be life threatening
What psychiatric reactions can be associated with high-dose steroid treatment?
Euphoria
insomnia
nightmares
irritability
suicidal thoughts
- these are more likely in those who have history of mental health
