Problem 14: Side effects related to repeat courses of steroids Flashcards
What might be causing the sore throat and how can this be solved? - steroids
May be caused by oral steroid increasing susceptibility to oral thrush. Mouth is red inside and you have white patches. Other symptoms include cracks at the corners of the mouth
not tasting things properly
an unpleasant taste in the mouth
pain inside the mouth, for example a sore tongue or sore gums
difficulty eating and drinking
Oesophageal reactions (sometimes severe and requiring hospitalisation), such as oesophagitis, oesophageal ulcers and oesophageal erosions, rarely followed by oesophageal stricture, have been reported in patients receiving alendronate.
Discuss the side effects of oral and inhaled corticosteroids, including the management of these.
Prednisolone (due to its high concentration of glucocorticoids) can exacerbate conditions such as osteoporosis. Some patients are prescribed prophylactic bisphosphonates for treatment of osteoporosis
Men aged 50 - 74 with treatment of oral corticosteroids should have a fragility fracture assessment done.
Side effects: Endocrine - adrenal insufficiency, weight gain, and diabetes mellitus (new-onset, or worsening of blood glucose control in existing diabetes mellitus).
Gastrointestinal - peptic ulceration with perforation and haemorrhage, dyspepsia, abdominal distension, and oesophageal ulceration; especially in high-risk people high-risk people.
Psychiatric - confusion, irritability, delusions and suicidal thoughts early in treatment and especially with high doses.
Musculoskeletal - osteoporosis and proximal myopathy.
Ophthalmic – glaucoma, cataract, blurred vision and other visual disturbances.
Cardiovascular - hypertension.
Skin - thinning of the skin, easy bruising, and delayed wound healing.
Other - immunosuppression, Cushing’s syndrome (this is usually reversible on withdrawal of treatment), and irreversible growth suppression in children and adolescents.
Describe the counselling for bisphosphonates including the reason for the counselling.
Dosed as ONE tablet per week. WEEKLY DOSE.
Must be taken at least 30 minutes before the first food, beverage or medicinal product of the day with plain water only.
Patients should not crush or chew the tablet or allow the tablet to dissolve in their mouths because of a potential for oropharyngeal ulceration.
Patients should not lie down until after their first food of the day which should be at least 30 minutes after taking the tablet.
• Patients should not lie down for at least 30 minutes after taking Alendronic Acid 70mg Tablets.
• Alendronic Acid 70mg Tablets should not be taken at bedtime or before arising for the day.
Patients should receive supplemental calcium and vitamin D if dietary intake is inadequate (see section 4.4).
Discuss the reasons why the steroid course was reduced gradually and how this is undertaken in practice?
Short courses of oral corticosteroids (less than 3 weeks) can be stopped abruptly.
Gradual withdrawal should be considered for people whose disease is unlikely to relapse and who have:
Received more than 3 weeks of corticosteroid treatment.
Recently received repeated courses of corticosteroids (especially if they have been taken for longer than 3 weeks), for example prescribed for the treatment of acute exacerbations of asthma.
A history of previous long-term therapy (months or years).
Other possible causes of adrenal suppression, such as excessive alcohol consumption or stress (for example due to infection, trauma, or surgery).
Received more than 40 mg prednisolone daily or equivalent for more than 1 week.
Been taking repeated evening doses of corticosteroids, which increases the risks of developing adrenal insufficiency.
If stress, for example caused by infection, trauma, or surgery occurs up to 1 week after stopping the corticosteroid, additional corticosteroid cover should be prescribed to compensate for any potential adrenal suppression.
During withdrawal, the dose of oral corticosteroids may be reduced rapidly down to physiological doses (about 7.5 mg of prednisolone or equivalent) and reduced more slowly thereafter. For a suggested withdrawal regime of oral prednisolone, see Table 3.
Explain the rationale for Peter being prescribed lansoprazole
NICE guidelines
Consider prescribing a proton pump inhibitor for gastrointestinal protection in people at high risk of gastrointestinal bleeding or dyspepsia. The risk factors for gastrointestinal adverse effects with oral corticosteroids include:
History of gastroduodenal ulcer, gastrointestinal bleeding, or gastroduodenal perforation.
Older age.
Concomitant use of drugs that are known to increase the risk of gastrointestinal bleeding, such as nonsteroidal anti-inflammatory drugs (for example aspirin and ibuprofen) and anticoagulants.
Serious comorbidity, such as advanced cancer.
Explain the role of mucolytics including any risk
Mucolytics are medicines that make the mucus (sputum) less thick and sticky and easier to cough up. They are usually prescribed for people who have a chronic (long-term) cough. They work best if they are taken regularly.
Side-effects of treatment with mucolytics occur only rarely but some people have reported bleeding from the gut (gastrointestinal tract) - this is rare. If you develop black stools (faeces), stop taking carbocisteine or erdosteine and let your doctor know as soon as possible. Black stools are a sign of bleeding from the gut.
Small evidence suggests that mucolytics can reduce the frequency of exacerbations and may also slightly improve quality of life.
