steroids

Question 1

Side effects of prednisolone?

Answer 1

• immunosuppression + Masking of acute infection
• osteoporosis with long term use
• catabolic on muscle, myopathy, wasting
• hyperglycaemia
• electrolyte disturbances
• cushingnoid appearance- buffalo hump, moon face, striae, abdominal adiposity
• poor healing, thin fragile skin due to atrophy
• fatigue
• water retention
• menstrual irregularity, amenorrhoea
• change in mood and behaviour

Question 2

why do we taper off the prednisolone dose?

Answer 2

We do this to avoid adrenal crisis–> addison disease like process. This is due to suppression of CRH, ACTH by prednisolone. Taking away the prednisolone suddenly will cause the patient to become sudden hypocortisolaemic.

Question 3

what do we need to ask the patient prior to commencing steroids?

Answer 3

do they have:

1. HIV
2. TB
3. Strongyloides
4. Hep B (chronic)

Question 4

what would we need to consider/monitor when we commence a patient on steroids?

Answer 4

BSLs, U and Es (hypokalemia and hypernatriemia and BP due to cross reactivity with mineralcorticoid receptors) + PPis due to increased acid secretion

Question 5

why would we not prescribe topical steroids to the eye for long periods of time?

Answer 5

will increase intraocular pressure in the eye (ocular hypertension)