Corticosteroids

Question 1

In what skin condition should corticosteroids be avoided? Or used only under specialist supervision?

Answer 1

Psoriasis

urticaria

pruritisu - depending

acne - no benefit

Question 2

What routes are corticosteroids given in UC and crohns?

Answer 2

topically - rectum, locally for haemorrhoids

systemically - mouth, IV

Question 3

does fludrocortisone have mineralocorticoid or glucocorticoid activity? and what is it used in?

Answer 3

mineralocorticoid

postural hypotension in autonomic neuropathy

Question 4

Can high dose CC be used in management of septic shock?

Answer 4

No

But lower doses of hydro & fludro is of benefit in adrenal insufficiency resulting from septic shock

Question 5

do dexamethasone and betamethasone have mineralocorticoid or glucocorticoid activity?

Answer 5

little/no mineralococrticoid

Question 6

when do glucocorticoids work best and why?

Answer 6

suppressive action on HPA axis is prolonged and greatest when given at night?

Question 7

what is the overnight dexamethasone test?

Answer 7

diagnoses cushing’s syndrome

given a single dose of dexamethasone at night which is sufficient to inhibit corticotropin secretion for 24 hours

Question 8

what CC is appropriate where water retention is not wanted?

Answer 8

betamethasone and dexamethasone

Question 9

can CC be used in management of raised intracranial pressure or cerebral oedema that occurs as a result of malignancy

Answer 9

yes

Question 10

can CC be used in management of head injury or stroke

Answer 10

no

no benefit/may harm

Question 11

what CC is used as an adjunct to adrenaline/epineprine in acute hypersensitivity reactions - angioedema/anaphylaxis

Answer 11

hydrocortisone as sodium succinate by IV

Question 12

when are inhaled CC used

Answer 12

in management of asthma and COPD

Question 13

when are systemic CC used (airway conditions)

Answer 13

treatment of acute asthma attack
severe cases of chronic asthma
exacerbations of COPD

Question 14

what are other conditions are CC useful in

Answer 14

autoimmune hepatitis
RA, sarcoidosis
remissions - acquired haemolytic anaemia, nephrotic syndrome, thrombocytopenic purpura

Question 15

what conditons can CC improve prognosis of but not necessarily cure?

Answer 15

SLE, temporal arteritis, polyarteritis nodosa

Question 16

MHRA alert with CC

Answer 16

CENTRAL SEROUS CHORIORETINOPATHY
- inhaled, intranasal, epidural, intra-articular, topical dermal, periocular

report any blurred visiion or visual disturbances when CC given by any route

Question 17

mineralocorticoid s/e

Answer 17

HTN, sodium retention, water retention, potassium loss, calcium loss

Question 18

CC with mineralocorticoid activity

Answer 18

1) fludrocortisone
2) hydrocortisone, corticotropin, tetracosactide

neglible with high potency glucocorticoids - betamethaosne and dexamethasone

occur only slightly with methylprednisolone, prednisolone, triamcinolone

Question 19

glucocorticoid s/e

Answer 19

diabetes, osteoporosis, avascular necrosis of femoral had, muscle wasting, peptic ulceration/perforation (weak link), psychiatric reactions

anti-inflammatory

Question 20

how to take CC to minimise side effects

Answer 20

use lowest effective dose for minimum period possible

The suppressive action of a corticosteroid on cortisol secretion is least when it is given as a single dose in the morning.

the total dose for two days can sometimes be taken as a single dose on alternate days; alternate-day administration has not been very successful in the management of asthma.

intermittent therapy with short courses.

reduce the dose of corticosteroid by adding a small dose of an immunosuppressive drug.

Question 21

effects of abrupt withdrawal after a prolonged period?

Answer 21

acute adrenal insufficiency, hypotension, death

fever, mylagia, athralgia, rhinitis, conjunctivitis, painful itchy nodules, weight loss

Question 22

when should gradual withdrawal of systemic CC be considered (in adults)

Answer 22

> 40mg prednisolone OD > 1 week (in children 2 mg/kg daily for 1 week or 1 mg/kg daily for 1 month)

repeat doses in evening

> 3 weeks treatment

repeated courses (esp if > 3week course)

short course within 1 year of stopping long term therapy

other poss causes of adrenal suppression

Question 23

when can systemic CC be stopped abruptly?

Answer 23

whos disease is unlikely to relapse + treatment < 3 weeks + not included in above pt groups

Question 24

how to reduce dose during withdrawal

Answer 24

During corticosteroid withdrawal the dose may be reduced rapidly down to physiological doses (equivalent to prednisolone 7.5 mg daily) and then reduced more slowly.

Question 25

when should steroid emrgency cards be issued

Answer 25

patients with adrenal insufficiency and steroid dependence for whom missed doses, illness, or surgery puts them at risk of adrenal crisis.

• those with primary adrenal insufficiency;
• those with adrenal insufficiency due to hypopituitarism requiring corticosteroid replacement;
• those taking corticosteroids at doses equivalent to, or exceeding, prednisolone 5 mg daily for 4 weeks or longer across all routes of administration (oral, topical, inhaled, intranasal, or intra-articular);
• those taking corticosteroids at doses equivalent to, or exceeding, prednisolone 40 mg daily for longer than 1 week, or repeated short oral courses;
• those taking a course of oral corticosteroids within 1 year of stopping long-term therapy.

Question 26

can you use topical corticosteroids in routine treatment of urticaria?

Answer 26

no

only be initiated and supervised by a specialist

Question 27

can you use topic CC in pruritus and acne?

Answer 27

not indiscriminately in pruritus - where only benefit if inflammation is causing the itch

no

Question 28

name the mild, mod, potent, very potent CC

Answer 28

check phone

Question 29

equivalent to pred 5mg

Answer 29

betamethasone 750mcg
deflazacort 6mg
dexamethasone 750mcg
hydrocortisone 20mg
methylprednisolone 4mg
triamcinolone 4mg