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PHA332 > Managing Steriods In Practise > Flashcards

Managing Steriods In Practise Flashcards

1
Q

What can steroids be used for?

A

A) to suppress inflammatory process
B) steroid replacement where body doesn’t make enough

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2
Q

Give an example of steroids being used to suppress an inflammatory process

A

Oral prednisone for a chest infection

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3
Q

What’s the difference between glucocorticoid and mineralocorticoid activity?

A

Glucocorticoid- regulate carbohydrate, protein and fat metabolism. It is an anti-inflammatory immunosuppressant
Mineralocorticoid- regulates fluid and electrolyte levels

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4
Q

What drug would you use for a chest infection and why?

A

A glucocorticoid based drug as it has higher anti inflammatory action unlike mineralocorticoids

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5
Q

Give examples of conditions where steroid replacement therapy is needed

A

Addisons disease
Hypopituitarism (pituitary tumour)
Congenital adrenal hyperplasia

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6
Q

What does the adrenal cortex secrete?

A

Cortisol (glucocorticoid activity)
Aldosterone (mineralocorticoid)

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7
Q

What drug is used to replace cortisol in s Teri I’d replacement therapy?

A

Hydrocortisone
Tablets 15-40mg, 2-3 times a day
Larger dose given in morning
Eg. 10mg OM, 5mg LT, 5mg TT

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8
Q

What drug replaces aldosterone in steroid replacement therapy?

A

Fludrocortisone
Used when adrenal cortex is destroyed (addisons)
Also used in HPoT due to fluid retaining properties
50-300mcg daily in morning

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9
Q

What is the symptoms of adrenal insufficiency?
Hint acronym

A

A ppetite loss, unintentional weight loss, abdominal pain
D iscolouration of the skin
D ehydration
I ncreased thirst and polyuria
S alt cravings
O ligomenorrhoea
N o energy/ fatigue/ low mood
S ore/ weakness in muscles or joints

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10
Q

What is adrenal crisis?

A

The adrenal glands can’t cope with the extra corticosteroids needed hence life threatening symptoms can develop

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11
Q

Name 3 symptoms of adrenal crisis

A

Severe vomiting and diarrhoea—-> dehydration
Abdominal pain
Severe muscle weakness/ cramps
Severe drowsiness and fatigue
Pyrexia
Dizziness, low BP
Confusion
Limb and back pain
Delirium or loss of consciousness

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12
Q

How is adrenal crisis treated?

A

IV fluids or steroids

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13
Q

All steroid dependant patients need to be issued a steroid emergency card, what patients does this include?

A

Patients on LT prednisolone 5mg daily
Addisons
Hypothalamopituitary dysfunction

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14
Q

What happens to the dose of steroid if the patient is ill, injured or undergoes strenuous exercise?

A
  1. Generally, double the dose of hydrocortisone if fever or on antibiotics until recovered
  2. Vomiting is dangerous, patients may use emergency hydrocortisone injection & seek medical attention
  3. Up to double doses with extra fluid intake for strenuous events such as marathon
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15
Q

Why is hydrocortisone acetate not used in an emergency injection situation? What drugs are used instead?

A

It has a delayed onset so no good for emergency
Hydrocortisone sodium phosphate 100mg or hydrocortisone sodium succinate 100mg are used instead

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16
Q

What drug and usual dose is used for an inflammatory disease?

A

Oral prednisolone
30mg daily (6x5mg tabs, take all together in morning)
May be short course then stopped abruptly but can be long course

17
Q

What are the desirable properties for glucocorticoid therapy?

A

High glucocorticoid activity
Relatively low mineralocorticoid activity

18
Q

What are some side effects of long term steroid use?

A

Mood and behaviour changes eg. Confusion, irritability, delusions and suicidal thoughts
Increased susceptibility to infections
Suppression of normal adrenal function

19
Q

What is classed as long term steroid treatment?

A

> 3 weeks

20
Q

How does adrenal crisis occur?

A

Chronic deficiency conditions
Cessation of LT steroids/ rapid dose decrease
Infection, trauma, surgery etc

21
Q

Name 3 side effects of short term steroid use and long term steroid use

A

ST- insomnia (take steroids in morning), mood disturbances and GI disturbances

LT- short course + increased susceptibility to infection, osteoporosis, adrenal suppression, cushingiod state, diabetes, skin changes (thinning, easy bruising), GI ulceration, hypokalaemia, growth retardation and fluid retention

22
Q

A rare condition can occur when on corticosteroids where patients are encouraged to report and visual disturbances, what is the condition?

A

Chorioretinopathy
A retinal disorder

23
Q

What are the contra indications of steroids?

A

Systemic infection (unless specific therapy given)
Avoid live virus vaccines

24
Q

Name 3 cautions of steriod therapy

A

Children
Elderly
Chronic heart failure
Peptic ulcer
Epilepsy
Diabetes
Pregnancy

25
Q

How do you minimise the side effects of steroids?

A

Morning dose to avoid insomnia
Minimise duration of course
Consider local application where possible
Alternate day dosing

26
Q

Can steroids worsen or improve blood glucose control?

A

Worsen
Steroid induced hyperglycaemia
Steroid induced diabetes

27
Q

Name the drug interactions with steroids

A

No major ones
NSAIDs can increase GI ulcer risk & so can steroids
Enzyme inducers may reduce serum conc of oral corticosteroids eg. Phenytoin and carbamazepine
Cholestyramine causes inhibition of GI absorption of oral corticosteroids with cholestyramine and other binding agents so doses should be separated from steriod

28
Q

When should steroids be tapered down to avoid adrenal crisis?

A

Over 3 weeks at any dose
>40mg prednisolone or equivalent for more than 1 week
Multiple recent repeated courses
Short course within a year of stopping long course
Been given repeated doses in evening

29
Q

How do you taper down steroids?

A

Decreasing the steriod dosage by the equivalent of 2.5mg of prednisolone every 3-7 days until physiologic dosage (7.5mg of prednisolone) is reached
Then more gradual reduction of 0.5-1mg every 2-4 weeks should be considered

30
Q

List 3 withdrawal symptoms of steroids

A

Fatigue
Weight loss
Abdominal pain
Nausea
Vomiting
Headaches
Fever
Dizziness
Confusion
Loss of consciousness
(Note all of these are symptoms of adrenal insufficiency)

31
Q

Give an example of a long, intermediate and short acting steroid

A

Long- dexamethasone, betamethasone
Intermediate- prednisolone
Short- cortisone, cortisol

32
Q

Why is a topical steroid not recommended if the person has an infection eg infected eczema?

A

Because it will spread the infection
(Unless they are on antibiotics for the infection already)

33
Q

What would the potency be like if the skin was thin?

A

Milder steroid would be prescribed

34
Q

Name a mild, moderate, potent and very potent steroid

A

Mild- hydrocortisone
Moderate- clobetasone, betamethasone
Potent- beclomethasone, betamethasone dipropionate
Very potent- clobetasol

35
Q

Describe the application of topical steroids

A

Apply thinly
Finger tip application- enough for twice size of adult palm
No more than twice daily
Use least potent formulation that is effective
Avoid prolonged use on face & keep away from eyes
Caution in children during pregnancy
Suppression of pituitary adrenal axis and Cushing syndrome can occur with prolonged use in large area

36
Q

Name 3 side effects of topical steroids

A

Thinning of skin (LT)
Contact dermatitis
Perioral dermatitis
Acne, worsening of acne rosacea
Depigmentation
Increased hair growth
Spread/ worsening of infection

37
Q

Is a ISC card required for clinic modulite <800mcg and Qvar <400mcg?

A

No

38
Q

What needs to be checked before a patients dose of steroid is increased?

A

Patient adherence
Inhaler technique (consider spacer)
Smoking cessation

39
Q

How is IBD treated? What route of administration?

A

Rectal route using enemas or suppositories

PHA332 (8 decks)

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