Steroids

Question 1

Steroid Pharmacology, Action

Answer 1

Act on intracellular receptors to alter gene transcription (clinical response delayed for a few days)

GLUCOCORTICOIDS
Inhibit synthesis of COX2 and inducible NO synthase
Inhibit synthesis of cytokines (interleukins, tumour necrosis factor,) and chemokines
Stimulate production of lipocortin (which inhibits PLA2 and the synthesis of prostaglandins leukotrienes)

Question 2

Uses of steroids (5)

Answer 2

Anti inflammatory 
Immunosuppressive
Replacement therapy
Neoplastic disease
Pre-term labour

Question 3

Steroids as anti inflammatory drugs / immunosuppressants

Answer 3

Allergic/ septic emergency (IV)
Asthma / COPD (inhaled/ oral)
UC / Crohn's (oral/ rectal)
Skin conditions - eczema/ psoriasis (topical/ oral)
RA (oral)
Organ transplantation 

Other inc. rhinitis, conjunctivitis.

Question 4

Steroids as replacement therapy

Answer 4

Addison's disease
Need for steroid replacement
Lifelong
Hydrocortisone
20mg AM, 10mg 6pm, and fludrocortisone

Question 5

Side effects of glucocorticoids

Answer 5

Long term oral (>3 weeks) may lead to:

Diabetes
Osteoporosis 
Mental disturbances
Peptic ulceration (esp. with NSAIDs)
Visual - cataract and glaucoma
Cushing's syndrome - at high dose
Suppression of growth - children
Adrenal suppression - sudden withdrawal can cause acute adrenal insufficiency, hypotension and death
Infections - increased susceptibility/ severity, particularly chickenpox (and measles) 

NB. Patients should have a Steroid Treatment Card
“I am on steroids which must not be stopped suddenly…”

Question 6

Mineralocorticoid effects

Answer 6

Aldosterone type effects, lead to:

Sodium and water retention
With potassium loss
And may cause hypertension/ worsen CHF

Question 7

Examples of steroids

Answer 7

GLUCOCORTICOIDS
Prednisolone (oral)
Beclometasone (inhaled for asthma)
Budesonide (asthma / lower GI)
Hydrocortisone (cortisol) (oral, topical, IV)

MINERALOCORTICOIDS
Fludrocortisone