Corticosteriods

Question 1

what are the two types of corticosteroids

Answer 1

-mineral corticosteroids
-glucosteriods

Question 2

what does mineral corticosteroids do?

Answer 2

high fluid retention low anti-inflammatory effect

Question 3

what does glucosteriods do

Answer 3

low fluid retention and high anti-inflammatory effect

Question 4

mineral corticosteroid with most activity

Answer 4

fludrocortisone

Question 5

mineral corticosteroid with second most activity

Answer 5

hydrocortisone

Question 6

which mineralcorticoid is used as tx for postural hypotension

Answer 6

fludrocortisone

Question 7

s/e of fludrocortisone

Answer 7

odema

Question 8

s/e of mineralcorticoids

Answer 8

-sodium + water retention = hypertension
-k+ loss = hypokalaemia
-ca+ loss = hypocalcaemia

Question 9

Which high potency glucorticoids are neligible with mineralcorticoid effects?

Answer 9

betamethasone and dexamethasone

Question 10

highest glucocorticoid steroid activity?

Answer 10

dexamethasone
betamethasone

Question 11

high glucocorticoid steroid activity?

Answer 11

prednisolone
prednisone
deflazacort

Question 12

glucocorticoids s/e

Answer 12

-diabetes
-osteoporosis
-avascular necrosis of femoral head and muscle
wasting
-gastric ulceration and perforation

Question 13

what is given alongside long-term steroid tx

Answer 13

PPI

Question 14

most common corticosteroid s/e

Answer 14

CORTICOSTEROID USE
-cushing syndrome
-osteoporosis
-retardation of growth
-thin skin
-immunosuppression + insomnia
-chorioretinopathy
-oedema
-striae
-emotional disturbance
-rise in BP
-obesity
-increased hair growth (hirsutism)
-diabetes mellitus (hypogly)
-ulcers (peptic)
-suppression (adrenal)
-electrolyte imbalance (hypokal)

Question 15

MHRA warning with corticosteroids

Answer 15

report blurred vision and visual disturbance

Question 16

s/e of corticosteriod

symptoms of psychiatric reactions

Answer 16

STOP and SEEK help if:
-insomnia
-instability
-mood change
-suicidal thoughts
-behavioural disturbances

Question 17

how is adrenal supression caused with cortiocosteriod use?

Answer 17

-prolonged use can cause adrenal atropy (can last yrs even after tx finished)
-abrupt withdrawal can cause acute adrenal insufficiency, hypotension or death

Question 18

what can occur if there is an temporary increase in dose or temporary reintroduction if stopped?

Answer 18

significant illness
trauma
surgical procedure

Question 19

corticosteroid s.e

what is infections a cause of?

Answer 19

immunosupression
-serious infections may reach to advanced stage before being recognised

Question 20

cortiocosteriod s/e

common infections with cortiocosteriod

Answer 20

-chickenpox
-measles

Question 21

chickenpox as a s/e of corticosteroid

Answer 21

-risk of severe chickenpox unless pt has immunity
-vaccines needed for non-immune pt
-if confirmed needs specialist care and urgent tx

Question 22

s/e of corticosteroid

measles prophylaxis

Answer 22

-prophylaxis with IM normal immunoglobin PRN
-seek immediate medical advise if exposure occurs

Question 23

corticosteroid s/e

when to take dose to avoid insomnia

Answer 23

take dose in morning

Question 24

corticosteroid s/e

s/e in children

Answer 24

retardation of growth
-including oral and inhalation

Question 25

# corticosteroid s/e what route is thinning skin assoc with

Answer 25

topical

Question 26

# corticosteroid s/e cushing sydrome symptoms and tx ## Footnote cushing= too much cortisol

Answer 26

-due to prolonged tx -**moonface, striae, hirustim** and **acne** **-managed** with **metyrapone** -**tx** with **ketoconazole** | striae= stretch marks

Question 27

managing s/e of corticosteroids

Answer 27

-lowest effect dose for min period -single dose morning -if 2DY course = AD -short courses -local tx rather than systemic

Question 28

when corticosteroids gradual withdrawal

Answer 28

-40mg+ or equiv predn OD 1WK -repeat evening doses - >3wk tx -recently repeated course -taking short course within 1yr of stopping longterm therapy -other causes of adrenal suppression

Question 29

topical steroid potency

Answer 29

-mild = hydrocortisone -moderate = clobetasone -potent = bethamethasone -v.potent = clobetasol

Question 30

which diseases cause adrenal sufficiency?

Answer 30

addisons disease or congential adrenal hyperplasia

Question 31

adrenal insufficiency tx

Answer 31

hydrocortisone -can also give fludrocortisone if primary insufficiency

Question 32

what can adrenal insufficiency lead to?

Answer 32

adrenal crisis

Question 33

adrenal insufficiency medical emergency tx

Answer 33

hydrocortisone

Question 34

symptoms of adrenal crisis

Answer 34

severe dehydration hypokalaemia shock altered consciousness seizures stroke cardiac arrest