Oral corticosteroids Flashcards
Name the 4 common clinical indications for the use of systemic oral corticosteroids.
1) Allergic or inflammatory disorders such as anaphylaxis or asthma.
2) Suppression of autoimmune disease such as IBD or inflammatory arthritis.
3) Some cancers as part of chemotherapy or to reduce tumour associated swelling.
4) Hormone replacement in adrenal insufficiency or hypopituitarism.
What is the basic mechanism of action of systemic corticosteroids?
Bind to cytosolic glucocorticoid receptors > receptors translocate to nucleus of cell > receptors bind to glucocorticoid response elements > regulation of gene expression.
Mainly a glucocorticoid effect.
1) What are corticosteroids most commonly prescribed to do?
2) What are the 2 main actions of corticosteroids?
1) Modify the immune response.
2) Downregulate pro-inflammatory genes (cytokines and TNF-alpha) and up regulate anti-inflammatory genes.
1) Direct action on anti-inflammatory cells includes action on which 2 types of cell?
2) What are the main metabolic effects of corticosteroids?
3) What are the mineralocorticoid effects of corticosteroids?
1) Monocytes and eosinophils.
2) Increased Gluconeogenesis from increased circulation of amino and fatty acids released by catabolism of muscle and fat.
3) Stimulate sodium and water retention and potassium excretion in renal tubule.
List 5 important adverse reactions of systemic corticosteroids.
1) Immunosuppression
2) DM and osteoporosis (metabolic)
3) Proximal muscle weakness, skin thinning, easy bruising and gastritis.
4) Mood and behavioural changes (insomnia, confusion, psychosis and suicidal ideation).
5) Hypertension, hypokalaemia and oedema (mineralocorticoid actions).
1) What is the process of the cause of adrenal atrophy in prolonged treatment with corticosteroids?
2) What does adrenal atrophy prevent?
3) What might happen if corticosteroids are withdrawn suddenly?
1) Suppresses pituitary ACTH secretion = switches off stimulus for normal adrenal cortisol production.
2) Prevents endogenous cortisol secretion.
3) An acute Addisonian crisis with CV collapse.
Name the 3 symptoms chronic glucocorticoid deficiency that occur during treatment withdrawal.
1) Fatigue
2) Weight loss
3) Arthralgia
In which two groups of people should corticosteroids be prescribed with caution in?
People with infection and children in whom they can suppress growth.
1) Corticosteroids increase the risk fo what 2 pathologies when used in conjunction with NSAIDs?
2) Corticosteroids increase the risk of hypokalaemia when used in combination with which 4 other classes of drug?
3) What might the efficacy of corticosteroids be reduced by?
4) What do corticosteroids do with regards to the immune response to vaccines?
1) Peptic ulceration and GI bleeding.
2) Beta 2 agonists, theophylline, loop diuretics, thiazide diuretics.
3) Cytochrome P450 inducers (phenytoin, carbamazepine and rifampicin).
4) They reduce the immune response to vaccines.
1) Name 3 systemic corticosteroids in order of potency from highest to lowest.
2) Give the 3 ways of administering systemic corticosteroids.
3) When and why should oral daily corticosteroid treatment be taken?
4) Name 3 long term risks of taking corticosteroids.
1) Dexamethasone, Prednisolone, Hydrocortisone.
2) Oral, IM, IV.
3) In the morning to mimic the natural circadian rhythm and to reduce insomnia.
4) Osteoporosis, increased risk of fractures, diabetes.
How might you want to monitor a patient to look for signs of the development of long term side effects?
1) DEXA scanning for osteoporosis.
2) HBA1C measurement for diabetes.
1) What might you need to do during acute illness of a patient on long term oral corticosteroid treatment?
2) Why might you want to do this?
1) Double the dose during acute illness and reduce back to maintenance dose on recovery.
2) Patients on long term corticosteroid therapy have atrophic adrenal glands and may be unable to increase cortisol secretion in response to stress. Therefore, this may be needed to be provided artificially by increasing the dose of exogenous corticosteroid.
