Therapeutic Use And Care Issues Of Corticosteroids W3 Flashcards
Glucocorticoid potency of hydrocortisone
One
Mineralocorticoid potency of hydrocortisone
One
Duration of action of hydrocortisone (t 1/2 hr)
Eight
Glucocorticoid potency of prednisolone
For
Mineralocorticoid potency of prednisone
0.8
Duration of action of prednisolone (t 1/2 hr)
16 to 36
Addison’s disease
Has a decrease in glucocorticoids (cortisol) and mineralacorticoids (aldosterone)
Need to replace them both:
- glucocorticoid effect drug = hydrocortisone
- mineralacorticoid effect drug = fludrocortisone
Another use of court case steroids
As anti-inflammatories and immuno suppressors
this requires steroids with glucocorticoid effects for example prednisone which is the most commonly used
Examples of when corticosteroids can be used as anti-inflammatories or immuno suppressesors
Asthma, inflammatory bowel disease, rheumatoid arthritis, eczema
Local effects of steroids
When used topically, side effects can be:
– skin thinning
– Skin infection
– Folliculitis
– Stretch marks
– Acne
When inhaled, side-effects can be:
– Hoarseness
– Throat irritation
– Candida infection
Systemic adverse effects
Occurs during long-term therapy(artificial steroids cause adrenal suppression)
Can be due to abrupt withdrawal (don’t stop artificial insulin suddenly) or intercurrent ill illness(use the sick day rule where you double the dose if missed)
Patient should always carry a steroid treatment card
Withdrawal of steroids
Gradually withdraw if:
– Taking more than 40 mg of prednisolone once a day for more than a week
– Already had three weeks + of treatment
– Recently received repeated courses
– Having a short course within one year of stopping long-term therapy
Prolonged courses of steroids can…..
increase the susceptibility and severity of infection
This is due to their immunosuppressive properties
A lot of patience on steroids maybe atypical so serious infection infections can reach an advanced stage before they’re actually recognised because the use of the steroid is actually suppressing the normal response and therefore the normal symptoms of that infection
Psychiatric reactions associated with steroids
Steroids have a direct effect on the brain and if used in high doses can cause problems that euphoria, nightmares and insomnia as well as irritability, mood, suicidal thoughts and psychiatric reactions
Other general side effects of steroids
Mineralacorticords can cause hypertension, sodium and water retention as well as potassium and calcium loss
Glucose can cause diabetes, osteoporosis, gastrointestinal disturbances, Cushing syndrome, growth suppression in children
The role of the pharmacist when it comes to steroids
Promote the use of the lowest dose for the shortest time possible
Ensure gradual withdrawal
Advise on increased dose requirements during illness
Supply a steroid card
Council side effects and ensure prophylactic treatment were appropriate, i.e. osteoporosis
