Steroids Flashcards
What are the glucocorticoid and mineralocorticoid activities of Fludrocortisone?
Minimal glucocorticoid activity,
very high mineralocorticoid activity
What are the glucocorticoid and mineralocorticoid activities of Hydrocortisone?
Glucocorticoid activity,
high mineralocorticoid activity
What are the glucocorticoid and mineralocorticoid activities of Prednisolone?
Predominant glucocorticoid activity,
low mineralocorticoid activity
What are the glucocorticoid and mineralocorticoid activities of Dexamethasone, Betmethasone?
Very high glucocorticoid activity,
minimal mineralocorticoid activity
What are the side-effects of glucocorticoids?
- endocrine: impaired glucose regulation, increased appetite/weight gain, hirsutism, hyperlipidaemia
- Cushing’s syndrome: moon face, buffalo hump, striae
- musculoskeletal: osteoporosis, proximal myopathy, avascular necrosis of the femoral head
- immunosuppression: increased susceptibility to severe infection, reactivation of tuberculosis
- psychiatric: insomnia, mania, depression, psychosis
- gastrointestinal: peptic ulceration, acute pancreatitis
- ophthalmic: glaucoma, cataracts
- suppression of growth in children
- intracranial hypertension
What are the side-effects of mineralocorticoids?
- fluid retention
- hypertension
What should patients on steroid do to their dose during a period of illness?
Double their dose of steroids
How long does a patient need to be on steroids before they have to consider a tapered withdrawal, and what is the potential problem in not doing so?
The BNF suggests gradual withdrawal of systemic corticosteroids if patients have: received more than 40mg prednisolone daily for more than one week, received more than 3 weeks treatment or recently received repeated courses.
Failure to do so can lead to an adrenal crisis (Addisonian crisis), as endogenous steroids have been suppressed.
