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PHA 332 > steroids in practice > Flashcards

steroids in practice Flashcards

1
Q

what are the two main types of steroids?

A

1- steroids to suppress anti inflammatory process

2-steroid replacement where the body doesnt make enough

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2
Q

what are some examples of steroids to suppress an anti-inflam process?

A

oral prendisolone to suppress chest infection

topical hydrocortisone for ezcema flare up

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3
Q

give an example of when steroid repacement may be necessary

A

oral hydrocortisone and fludrcortisone in addison’s disease

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4
Q

what are the two main properties of corticosteroids?

A

glucocorticoid- regulate carb, protein and fat metabolism. also an anti-inflamatory and immunosuppressant
mineralocortoid- regulate fluid and electrolyte levels

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5
Q

what does the choice of corticosteroid depend on?

A

depends on indication
e.g. fludorcortisone acetate has a high mineralocorticoid activity while little inflammatory action therefore you wouldn’t use this for a chest infection

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6
Q

what do we refer back to for the dose equivilant of certain steroids?

A

in the bnf = 5mg of prednisolone

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7
Q

when would you use physiological replacement in deficient states?

A

addison’s disease- destruction of adrenal cortex
hypopituraism -pituitary tumour- release of ACTH
congenital renal hyperplasia

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8
Q

what does the adrenal cortex normally secrete?

A

cortisol- glucorticoid activity and weak mineralocortcoid activity
aldosterone- mineralocortcoid

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9
Q

what is the function of cortisol?

A

primary hormone of importance in acute adrenal crisis

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10
Q

what is used to replace cortisol?

A

oral hydrocortisone tablets- iv or im in crisis

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11
Q

what does aldosterone do?

A

acts to promote reabsorption and promote potassium excretion

promotes sodium retention

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12
Q

what does a deficiency in aldosterone cause?

A

sodium loss, hypotension and volume depletion

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13
Q

what is used to replace aldosterone?

A

fludrocortisone 50-300 micrograms daily in the morning

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14
Q

what does biochemical monitoring allow for?

A

detection of minor degrees of under or over replacement

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15
Q

what are the symptoms that people with adrenal insufficiency may experience?

A 
Appetite loss
Discolouration of the skin
Dehydration
Increased thirst and polyuria
Salt cravings
Olignomemorrhea
No energy/ faituge
Sore/ weakness in muscle joints
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16
Q

when do you notice people with adrenal insufficency?

A

they will remain well usually until times of cricis such as adrenal insufficency

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17
Q

what is an adrenal crisis?

A

it is a medical emergency
the adrenal glands cant cope with the extra corticosteroids needed and life threatening symptoms may develop
acute deteoriation in health status with marked hypotension (systolic <100 or at least 20 cognitive drop)

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18
Q

what are the signs and symptoms of an adrenal crisis?

A 
can appear quick:
vomiting and diarrhoea
abdominal pain
drowsiness/ fatigue
diziness
confusion
limb and back pain
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19
Q

what advice should be given to patients who are on steroid replacement?

A
  • should be regularly reviewed
  • this is a life long therapy
  • free prescriptions available- have enough
  • carry extra medication when travelling
  • steoid card/ emergency bracelet
  • ensure health professionals are aware
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20
Q

who should steroid cards be given to?

A

people on long term prendnsolone 5mg or more

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21
Q

what happens if a person with steroid replacment is ill or has undergone strenous exercise?

A

corticoids are increased due to the risk of adrenal crisis
-may have an individual plan
generally just doubled

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22
Q

what happens if a person with steroid replacement therapy is vomiting?

A

may use emergency hydrocotisone injection and seek immediate medical attention

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23
Q

what hydrocortisone should be given in an emergency?

A

hydrocortisone sodium not acetate as it has delayed onset of action

24
Q

what is the most common treatment for suppression of inflammatory diseases?

A

oral prednisolone 30mg daily

25
Q

when do steroids need to be tapered down?

A

usually if its a long course treatment- more than 3 weeks

26
Q

is short and long term use of glucocorticoids harmful?

A

short-not harmful

long term- more harmful

27
Q

how should patients be advised on how to take steroids?

A

in the morning after food to avoid GI disturbances and insominia

28
Q

what mood chages are associated with steroids?

A

confusion, irritability, sucidial thoughts
usually associated with higher doses- early treatment or when being withdrawn
seek medical advice if any changes occur

29
Q

what problems may people with long term steroid use have?

A

susceptibility to infection

suppression of normal adrenal function

30
Q

who should people with long term steroid use avoid ?

A

chicken pox or measles

31
Q

how can adrenal crisis occur?

A

chronic deficieny conditions
lt steroids\ dose decrease
infection, trauma, surgery

32
Q

what are the potential side effects of short term steroids?

A

insomina
mood disturbances
gi disturbances

33
Q

what are the potential side effects of long term steroids?

A 
same as a short course plus;
increased susptibility to infectin
osteoporosis
adrenal suppression
diabtes
occular effects
skin changes
gi bruising
hypokalemia
skin changes
skin bruising
34
Q

who are the people to be cautious about with steroid use?

A 
children and adoslecents
elderly
recent cv event
peptic ulcer
diabtes
pregnancyeplipsy
renal failure
glaucoma
35
Q

what are te c/i in steroid treatment?

A

systemic infections

avoid live viruses

36
Q

how do you minimise the s/e of steorid?

A 
morning dose
eaten before hand
alt day dosing
shortest course of treatment
topical application?
37
Q

how does steroids affect diabetes?

A

steroids can worsen diabetes
it can worsen blood glucose control
increased monitoring necessary

38
Q

how does steroids affect surgery?

A

increased stress- most likely increase dose of steroids or iv steroids if necessary

39
Q

how does glucocorticoid induced osteporosis occur?

A

rate of bone density loss is highest at the start of treatment
continued reduction with long term use
need to take into acccount patients fracture risk

40
Q

if a person is of high fracure risk what therapy should they be put on?

A

biophosphate +- calcuim / vit d

41
Q

what is said about the use of steroids in pregnancy and breast feeding

A

variable ability of corticosteroids to cross placenta
no signifigant evidence that corticosteroids cause congenital abnormalities
increased risk of intra-urine growth restriction with prolonged or repeated admin
adrenal suppression in neonate resolves after birth

42
Q

what drug interactions would you avoid if possible with corticosteroids?

A

NSAIDS
enzyme inducers
cholestyramine

43
Q

when do you have to taper the withdrawl of oral corticosteroids?

A

when there is a likely degree of adrenal suppression:
>3 weeks any dose
>40mg prednisolone or equivilant for more than 1 week
multiple recent repeated courses
short course within a year of stopping a long course
been given repeated doses in the evening

44
Q

how do you taper oral steroids?

A

Indication, duration & intensity of treatment

impact on how and when tapering required

45
Q

what does slow tapering of oral corticosteroids involve

A

-decreasing the steroid dosage by the equivilant of 2.5-5mg of prendisone every 3-7 days until the physiological dosage is reached
then a more gradual reduction of prednisolone 0.5-1mg every 2-4 weeks should be considered

46
Q

what are the symptoms of adrenal insufficiency?

A 
Fatigue
• Weight loss
• Abdominal pain
• Nausea
• Vomiting
• Headaches
• Joint pains
• Dizziness
• Fever
• Hypotension
• Confusion
• Loss of consciousness
47
Q

how does an intra-articular steroid injection work?

A

Insoluble/long-acting steroid remains in the joint, contact with inflamed synovial surface, taken up by synovial cells and absorbed
into blood stream
-side effecrs less

48
Q

when should topical corticosteroids be given?

A

inflammatory condition of the skin other than infection.

• E.g. eczema, contact dermatitis, insect sting, eczema of scabies

49
Q

when should topical corticosteroids not be given?

A

infection (bacteria/viral/fungal) unless

concomitant treatment e.g. antibiotic/antifungal, rosacea

50
Q

when and where should potent topical steroids be avoided?

A 
Potent topical steroid 
should generally be avoided 
on the face and skin flexures 
except under special 
circumstances by specialist 
supervision
51
Q

how would you council someone on the ammount of cream to apply?

A

• Finger tip application

– Enough for twice size of adult palm+fingers

52
Q

what other counselling points would you give to someone with a topical steroid?

A

• No more frequently than twice daily (once daily normally sufficient) apply
thinly to the affected area only
• Use the least potent formulation which is fully effective
• Avoid prolonged use on the face and keep away from eyes
• Caution in children and during pregnancy

53
Q

what are the side effects of topical steroids?

A 
• Spread/worsening of untreated infection (do not use 
on infected skin unless specific treatment for 
infection given alongside)
• Thinning of skin with long-term use
• Contact dermatitis
• Perioral dermatitis
• Acne, worsening of acne rosacea
• Depigmentation
• Hypertrichosi
54
Q

what are the risk of systemic side effects of ICS at high doses?

A 
• Spread/worsening of untreated infection (do not use 
on infected skin unless specific treatment for 
infection given alongside)
• Thinning of skin with long-term use
• Contact dermatitis
• Perioral dermatitis
• Acne, worsening of acne rosacea
• Depigmentation
• Hypertrichosi
55
Q

before increasing the dose of inhaled steroids what should you check?

A

• Patient adherence
• Inhaler technique
?consider spacer
• Encourage smoking cessation

56
Q

when would rectal steroids be used?

A

Enemas or suppositories e.g. prednisolone in
inflammatory bowel disease (IBD) affecting
lower parts of the colon and rectum
– Local action

PHA 332 (42 decks)

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