Wk 11: Managing steroids in practice: Steroid safety

Question 1

What are some causes of adrenal crisis?

Answer 1

• Chronic deficiency conditions
• Cessation of LT steroids/rapid dose dec (adrenal insufficiency)
• Infection, trauma, surgery

Question 2

What are side effects of short-term use of corticosteroid?

Answer 2

• Insomnia
• Mood disturbances
• GI disturbances

Question 3

What are side effects of long-term use of corticosteroid?

Answer 3

• Infection
• Osteoporosis
• Adrenal suppression
• Cushingoid state
• Diabetes
• Ocular effects
• Skin thinning/bruising
• GI ulceration
• Growth retardation (in children)
• Hypokalaemia
• Fluid retention

Question 4

What are the contraindications of corticosteroid therapy?

Answer 4

• Systemic infection

- Avoid live virus vaccines

Question 5

What are the monitoring requirements for side effects on long term treatment?

Answer 5

• Body weight
• Growth charts children
• BP
• Signs of oedema
• Lipid levels
• Glucose levels
• Ocular pressure
• Cardiac insufficiency
• Bone Mineral Density/ FRAX

Question 6

What are the effects of steroids on diabetes?

Answer 6

• Worsen blood glucose control
• Rise blood glucose 4-8hrs post oral steroid
• Inc monitoring

Question 7

What are the effects of surgery on steroid therapy?

Answer 7

• Inc steroid requirement due to physiological stress

- Hydrocortisone during surgery: 100mg IV/IM + every 6hrs during operation until eating + drinking

Question 8

What are the effects of glucocorticoid on osteoporosis?

Answer 8

• Rate of bone density loss highest at start of treatment

- High risk: biphosphate +/- calcium + vit D

Question 9

What are the effects of steroid therapy on pregnancy + breastfeeding

Answer 9

• Inc risk of intra-uterine growth w/ prolong/repeated use

- Small amounts found in breast milk

Question 10

What are some drug interactions when undergoing steroid therapy?

Answer 10

• NSAIDS

- Cholestyramine: inhibit GI absorption of oral corticosteroid

Question 11

When do you taper oral corticosteroid?

Answer 11

• > 3 weeks any dose
• > 40mg prednisolone (or equivalent) for >1 week
• Multiple repeated course
• Short term w/in year of stopping long course
• Repeated doses in evening

Question 12

What does slow tapering of oral corticosteroids involve?

Answer 12

• Dec steroid dosage by equivalent of 2.5-5mg of prednisone every 3-7 days until physiological dosage reached (7.5mg)
• Then gradual red of prednisolone 0.5-1mg every 2 to 4 weeks

Question 13

What are the symptoms of withdrawal?

Answer 13

Same as adrenal insufficiency:

• GI disturbance
• Dizzy
• Drowsy