Oral corticosteroids

Question 1

oral corticosteroids - indications

Answer 1

1) To treat allergic or inflammatory disorders: anaphylaxis, asthma.
2) Suppression of autoimmune disease: IBD, inflammatory arthritis.
3) In the treatment of some cancers as part of chemotherapy or to reduce tumour-associated swelling.
4) Hormone replacement in adrenal insufficiency or hypopituitarism.

Question 2

oral corticosteroids - examples

PHD

Answer 2

prednisolone

hydrocortisone

dexamethasone

Question 3

oral corticosteroids - MOA

Answer 3

• Corticosteroids are most commonly prescribed to modify the immune response.
• They upregulate antiinflammatory genes and downregulate pro-inflammatory genes
• Metabolic effects: increased gluconeogenesis
• Mineralocorticoid effects, stimulating Na+ and water retention and K+ excretion in the renal tubule.

Question 4

oral corticosteroids - adverse effects

Answer 4

1) Immunosuppression increases the risk and severity of the infection and alters the host response.
2) Metabolic effects: diabetes mellitus and osteoporosis.
3) Muscle weakness, skin thinning with easy bruising
4) Gastritis
5) Mood and behavioural changes: insomnia, confusion, psychosis and suicidal ideas.
6) Hypertension, hypokalaemia and oedema
7) Prolonged treatment = adrenal atrophy which can result in an acute Addisonian crisis with Cardiovascular collapse

Question 5

Oral corticosteroids - what may be experience during treatment withdrawal?

Answer 5

• fatigue
• weight loss
• arthralgia.

Question 6

Oral corticosteroids - used with caution in..

Answer 6

• people with infection

- in children: can suppress growth

Question 7

Oral corticosteroids - interactions

Answer 7

NSAIDs
Why? Increase the risk of peptic ulceration and GI bleeding when used with

β2-agonists, theophylline, loop or thiazide diuretics
Why? enhances hypokalaemia

Cytochrome P450 inducers (e.g. phenytoin, carbamazepine, rifampicin).

Corticosteroids reduce the immune response to vaccines.