steroids Flashcards
what is the MHRA warning side efffect associated with corticosteroids associated with all of its forms
chorioretinopathy
retinal disorder with local and systemic use
recently been reported through use of local admin routes- inhalation, intranasal, topical, epidural
report any blurred vision or visual disturbance
refer to opthalmogist
what is mineralocorticoid activity?
which steroid hs the most mineralcorticod activity
works on water and electrolytes balance- holds water in body whihchraises blood pressure so it used in ppl with lower bp
fludrocortisone
what is glucocorticoid activity?
anti-inflammatory/ reduce immune repsonse
example of a steroid that has both glucocoticoid and mineralcorticoidactivity
Hydrocortisone
example of glucocorticoid steroids
dexa
pred
Side effect of gluticosteroids
diabetic bodybuilders are psychos and get stomach ulcers from eating broken bones
cushings sydrome moon face Hyperglycaemia Osteoporosis esp in eldely muscle wasting- myopathy peptic ulceration/perforation psychiatric reactions
what are the side effects of mineralcorticoid side effects
memory trick: water retention, Na retention, hypertension
Hypertensionsodium retention water retention potassium loss calcium loss occurs most with fludrocortisone least seen with betamethasone and dexametasone due to their high glucocorticoid potency
what is adrenal suppression?
what is it caused by the majority of the time
adrenal glands do not produce adequate amounts of cortocisteroids primarily cortisol and the mineralcorticoid aldosterone which regullates Na and K and water retention
addisons disease
which hormones are secreted by the adrenal cortex and regulate NA and K and water balance
aldosterone
cortisol
what is the difference between addisons and cushings disease
crushing
adding
cushings- too much steroid
addisons- too little steroid
what are teh symptoms of addisons disease
salt craving because it causes hypernatraemia hyponatraemia Hypoglycaemia weight loss\hyperkalemia hypotension n and v anorexia fatigue
how do we minimise corticosteroids side effects
lowest dose for shortest time
in Morning single dose
local treatment rather than systemic
large volume spacer devices if higher doses required
how is adrenal deficiency treated
physiological replacement- combo of hydrocortsione and fludrocortisone- it mimics the bodys natural steroids
provides fludrocrtisone which is aldosterone (a mineralcoticosteroid) and cortisol from hydrsotisone which is a glucocorticoid
which steroid has the highest and second highest glucocorticoid actvitvity
when are they appropriate to use
beclometasone
dexametasone
long duration of action
siutable for therapies where fluid retention is not required
high glucocorticoid activity needs minimal mineralcorticoids
high glucocoticoid activity only benefit as long as it is accompanied by low mineralcorticoid activity
(this means anti-inflammation therapy with these drugs only works when there is minimal activity trying to retain water such as fludrocotisone
what are the s/e increased risks due to of systemic steroids
Blurred vision/disturbance
adrenal suppression- using for a long time, abrupt withdrawal
infection- reduce immune system so increased risk of infectsions
psychiatruc reactions- seek gp to reduce
chicken pox unless they have alrady head - eledlry will have vaccine
measles- avoid exposure
can steroids be used in preganancy
benefit ouutweighs the risk
when dom you reduce steroids gradually compard to abruptly
Gradual withdrawal for patienst whose disease is unlikely to relapse and have
recieved more than 40mg pred or equivalent daily for overr a week
had repeat doses in evening
recently recieved repeat course esp if for over 3 weeks
taken short course within year of long course
more than 3 weeks treatment
other causes of adrenal suppression
what is hyperthroidism characterised by
too much thyroxine (t4)/ t3 which is the inactive form
low TSH
symptoms of hyperthyoidism
goitre disturbed sleep hyperactivity heat intolerance unintentional weight loss complications- thyroid storm, preganancy complications, HF, AF, reduced bone mineral density
drugs to treat hyperthyroidism
used to either prepare pts for thyroidectomy or long term management
carbimazole
propylthiouracil
both interefere with synthesis of thyroid hormones
what is the blocking replacement regimen
for which type of pts can’t use this therapy
mixture of carbimazole and levothyroxine so pt isnt hypo or hyperthoidism- balance
pregnancy
antithyroid drugs that are not carbimazole or propylthiouracil
iodine- adjunct antithyroid drugs avoid long term
radioactive sodium iodide: treatment of thyrotoxicosis
Propanolol: reliefs thyrototoxic symptoms- can be used in conjuction with iodine
what is thyrotoxic crisis (thyroid storm)
how is it treated
medical emergency- rapid hr, temp, loss of consciouseness, jaundice, vomiting
I.V fluids
propanolol- blocks conversion of t4 to active form t3
hydrocotisone
oralniodine, carbimazole, propyluthiouracil
which antihyperthyroid drugs can be used in pregnancy in a thyroid storm- which trimester
cross the placenta and can cause fetal goitre and hypothyroidism
1st trimester: propylthiouracil not later because it can destroy liver
2nd/3rd trimester: carbimazole and no earlier becuase it can cause brain damage
important safety advice with carbimazole
neutropenia and agranulocytosis
bone marrow suppression- stop treatment immediately
report signs of infections- esp sore throat
WBC at any sign of infection
stop promptly at any sign of infection
what the counselling advice to give with carbimazole
tell dr immediately if sore throat, mouth ulcers, bruising, fever, malaise or non specific illness develops
MHRA Advice for carbimazole
acute pancreatitis
congenital defects in first trimester
monititoring and advice for propylthiouracil
hepatoxcity- pt look out for signs
stop if liver enzyme problems develo0ps
what is hypothyroidism
underproduction of Thyroid hormones
high tsh and low t4
signs and symptoms of hypothyrodism
fatigue weight gain constipation mesntrual irregularities intolerance to col
hypothydoism causes
iodine deficnecy automine radiotherapty surgery drugs pituitary disorder
hypothyroid drugs
levothryroxine- drug of choice
liothyronine- more rapidly metabolised and more rapid effect. used in more severe hypothyroid states when a rapid response is required.- treatment of choice in hyperthyroid coma
indications of hypothyroidism drugs
diffuse goitre
hypothroidism
thyroid carcinoma
risk factors of osteoporosis
lifestyle early menopause RA Diabetes history of fractures
medications used in post menopoausal osteoporosis
oral bisphosphonates- alendronic acid and risedronate- both reduce fractures
if contraindicated. use ibandronic acid or desunomab or raloxifene
HRT- restricetd to younger post menopausal woomen due to cardiovascular risk and cancer
treatment for glucocorticosteroid osteoprosis
glucocorticoid cause bone loss- usually when you start treatment
prophylaxis is bisphospohonates
list line for osteoporosis in men
oral bisphosphonates 1st line
absorb to crystals in the bone to slow down the process of them breaking dow bone turnover
mhra for bisphophonates
2 years plus
- atypical femoral fracture- pain in hips thigh, groin so need to report to dr
osetonecrosis- pain in jaw- not enough blood goes to jaw- need to maintain good oral hygiene. greater with I.V
Oseteonecrosis of external auditory canal: report signs of ear pain, discharge from ear or ear infection
side effects for alendronic acid
oesophageal reactions- syphagia, heartburn, pain on swallowing, retrosternal pain
report to dr immediately
counselling for alendronic acid
swallow whole on single 100ml dose
taken on empty stomach 30 mins before breakfast or any other oral med
sitting or standing with plenty of water
sit or stand upright for 30 minutes after taking the dose
what is HRT and what is it used for
uses oestrogen and progestrogen to alleviate symptoms of menopause
signs of menopause
hot flusses vaginal atrophy, dryness bone loss sexual dysgunction decreased muscle mass accelerated skin aging
what age is early menopuse
what age is natural menopause
less than 45
greater than 50§
which hormonal activity does tibolone exhibit
oestrogenic , progestogenic and androgenic activity
when is progestrogen given to women with menopause
women with a uterus on long term therapy to reduce risk of endometrial cancer and cystic hyperplasia
which causes throboembolism : oestrogen or progestrogen
oestrogen
clonidine indication
menopausal symptoms in women who can’t take oestrogen but may cause unacceceptable side effects
risks from HRT
Breast cancer
wndometrial cancer- risk reduced with progesterogen
ovarian cancer
VTE
stroke
CHD
Benefit outweighs risk for under 60yr olds
moment you stop HRT then the riak reduces
risk of breast cancer in HRT
all types of hrt increase the risk off the breast cancer within 1-2 years of initiating treatment
risk disappears within 5 years of stopping
Risk of endometrial cancer in HRT
Depends on dose ad duration
cyclically reduces risk of cancer
risk eliminated with progestrogen but higher risk of breast cancer
which hrt has high risk of stroke
tibolone increaes risk by 2.2 in first year
when can oestrogen be given alone
without a uterus unless in endometreosis where you give progestrogen as well
how soon do you need to stop hrt before surgery
stop 4-6 weeks before surgery
reasons to stop HRT
dvt signs jaundice neurological effects breath;ess stomach pain
sex hormones ethinylestradiol and raloxifene indications
short term symptoms of oetrogen deficiency
osteoporosis prophylaxis
female hypogonadism and menstrual disorders
raloxifene
treatment and prevention of postmenopausal osteoprosis
dose not releive menopausal vasomotor symptoms e.g hot flushes
testostetone analogues
norethisterone, norgestrel
progesterone and analogues
dydrogesterone and medroxyprogesterone
