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
