STEROIDS Flashcards
When and why are inhaled steroids used?
- Asthma - when PRN insufficient
- COPD - symptom control
immunosuppressive and anti-inflammatory effects
(beclametasone fluticasone, budesonide)
ADRs of inhaled steroids
oral thrush (candidiasis) hoarse voice
Why are systemic side effects not seen with ICS use?
inhaled ICS not very well absorbed into blood
Advice RE inhaled steroids
wash mouth/gargle after ICS
inhaler technique
ADRs of systemic steroids
Stomach ulcers Thin skin Oedema RHF/LHF Osteoporosis Infection/immunosupression DM/Cushings
mood changes, proximal muscle weakness
Risk of prolonged steroid use
Adrenal insufficiency (exogenous steroids = reduce drive of adrenals to produce their own steroid hormones)
Systemic steroids and children
growth suppression
What drugs may systemic steroids interact with?
NSAIDs - GI bleeding + peptic ulcers
Loop/thiazide diuretics - hypoK+
Co-prescribing with systemic steroids
In at risk people/long term steroid use:
- bisphosphonates - osteoporosis
- PPI - GI ulcers/bleed
To enhance effects of steroids - steroid sparing immunosuppressants
- MTX
- azathioprine
When should systemic steroids be taken?
OD in the morning - to replicate circadian rhythm and reduce insomnia
Patient advice RE prolonged systemic steroids
- do NOT stop suddenly
- carry a steroid card
Sick day rules with systemic steroids
Double dose in acute illness/surgery
- reduce back to maintenance dose on recovery
Steroids and monitoring
- PEFR for asthma
- CRP/ESR for inflammatory conditions
- DEXA/HbA1c - long term
Topical steroid use and ADRs
used for eczema
ADRs localised to site of eczema/skin
- thin skin
- striae
Caution and administration advice when using topical steroids
risk of skin damage if applied to wrong areas or for too long - use only a small amount to cover surface
don’t use in infection as broken skin - can worsen
avoid using potent agents on face/keep rx duration short
