Systematic corticosteroids (prednisolone) and inhaled corticosteroids Flashcards
Name examples of inhaled corticosteroids.
Beclometasone, budesonide, fluticasone, mometasone, ciclesonide.
What are the indications of systemic prednisolone?
Acute exacerbation of COPD, croup, asthma (mild-severe), suppression of inflammatory and allergic disorders, idiopathic thrombocytopenic purpura, ulcerative colitis,
Crohn’s disease, neuritic pain or weakness heralding rapid onset of permanent nerve damage, generalised myasthenia gravis, ocular myasthenia, reduction in rate of joint destruction in moderate to severe rheumatoid arthritis, polymyalgia rheumatica, giant cell (temporal) arteritis, polyarteritis nodosa, polymyositis, systemic lupus erythematosus.
What are the contraindications of systemic prednisolone?
Avoid injections containing benzyl alcohol in neonates, avoid live virus vaccines in those receiving immunosuppressive doses, systemic infection.
What are the indications of inhaled corticosteroids?
prophylaxis of asthma, prophylaxis and treatment of allergic and vasomotor rhinitis, nasal polyps.
What are the contraindications of nasal budesonide?
Avoid after nasal surgery (until healing has occurred), avoid in pulmonary tuberculosis, avoid in the presence of untreated nasal infections.
What is the mechanism of action of corticosteroids?
Corticosteroids/glucocorticoids are naturally occurring steroid hormones that are normally synthesised and secreted by the cortex of the adrenal glands and have anti-inflammatory and immunosuppressive effects. Glucocorticoids are lipid soluble, crossing the plasma membrane and entering the cell, where they bind to glucocorticoid receptors in the cytoplasm. The receptor-steroid complex migrates to the nucleus where it binds to specific regions of DNA, resulting in a change in gene activity.
For example, when transcription of the gene responsible for production of the enzyme phospholipase A2 is inhibited, this inhibits the release of arachidonic acid from membrane phospholipids and therefore production of prostaglandins, thromboxanes and leukotrienes are reduced, leading to a reduction in inflammation at the targeted area.
What are the common/very common side effects of systemic prednisolone that can occur with prolonged high doses?
weight gain, increased fat on chest and stomach with slim arms and legs, build-up of fat on the back of neck and shoulders, red, puffy, rounded face, skin that bruises easily, large purple stretch marks, weakness in upper arms and thighs, low libido, fertility problems, depression, mood swings, acne, oedema, osteoporosis, diabetes mellitus, metabolic syndrome, impaired healing, menstrual irregularities, immunosuppression, growth retardation, sleep disturbances.
What are the common/very common side effects of inhaled corticosteroids?
oral candidiasis/thrush
What are the monitoring requirements for corticosteroids in children?
height and weight of children receiving prolonged treatment with corticosteroids should be monitored annually and if growth is slowed refer to a paediatrician.
What is the treatment cessation protocol for systemic corticosteroids?
Magnitude/speed of dose reduction in corticosteroid withdrawal should be determined on a case-by-case basis, taking into account the underlying condition, likelihood of relapse and duration of treatment.
Gradual withdrawal should be considered in in those whose disease is likely to relapse and who have received more than 40 mg prednisolone daily for more than 1 week, 2 mg/kg daily for 1 week, 1 mg/kg daily for 1 month; for patients who have been given repeated doses in the evening, who have received more than 3 weeks treatment, have recently repeated courses, taken a short course within 1 year of stopping long-term therapy, or have other possible causes of adrenal suppression.
During withdrawal, reduce dose rapidly down to physiological doses (equiv. to 2-2.5 mg/m2 prednisolone daily) then reduce more slowly. Assess disease during withdrawal to ensure relapse does not occur.
What is the patient/carer advice for systemic corticosteroids?
Patients on long-term treatment should carry a steroid treatment card and a patient information leaflet should be provided to patients when drug is prescribed. Also advise patients of potential for immunosuppression, such as increased susceptibility to infections and if not already immune, patients at increased risk of severe chickenpox and measles and should avoid contact with people who are known to have those diseases. Also advise patients to not stop treatment abruptly if given longer than 3 weeks due to adrenal suppression which can lead to acute adrenal insufficiency, hypotension or death. Advise patients of potential for mood and behaviour changes such as confusion, irritability, depression, delusion, and suicidal thoughts. Also advise patients of potential for other serious effects such as GI, musculoskeletal and ophthalmic effects to occur which require medical attention.
What is the patient/carer advice for inhaled corticosteroids?
Advise patients/carers on inhalation techniques and/or the use of spacer devices. Steroid cards should be issued with high doses of inhaled beclometasone.
