corticosteroids

Question 1

why should patients report any blurred vision or other visual disturbances with corticosteroid treatment given by any route

Answer 1

because Central serous chorioretinopathy is a retinal disorder that has been linked to the use of corticosteroids

Question 2

what are the Mineralocorticoid side effects

Answer 2

• hypertension
• sodium retention
• water retention
• potassium loss
• calcium loss

Question 3

what are the Glucocorticoid side effects

Answer 3

• diabetes
• osteoporosis (which is a danger, particularly in the elderly, as it can result in osteoporotic fractures for example of the hip or vertebrae). High doses are associated with avascular necrosis of the femoral head (when blood supply to the bone is interrupted. leads to disabling arthritis)
• muscle wasting (proximal myopathy) can also occur
• corticosteroid therapy is also weakly linked with peptic ulceration and perforation
• psychiatric reactions may also occur

Question 4

how do you minimise side effects of corticosteroids

Answer 4

by using the lowest effective dose for the minimum period possible. can also:

• give a single dose in the morning (suppressive action least in morning)
• the total dose for two days can sometimes be taken as a single dose on alternate days
• intermittent therapy with short courses

Question 5

which patients should be issued a Steroid Emergency Card

Answer 5

patients with adrenal insufficiency and steroid dependence who are at risk of adrenal crisis

Question 6

what does the adrenal cortex secrete in normal healthy individuals

Answer 6

secretes CORTISOL (glucocorticoid) and ALDOSTERONE (mineralocorticoid).

note: cortisol- helps regulate metabolism and helps your body respond to stress. aldosterone- helps control blood pressure

Question 7

name 2 corticosteroids which have very high glucocorticoid activity and insignificant mineralocorticoid activity

Answer 7

Dexamethasone and Betamethasone

Question 8

what is the MHRA warning associated with long-term continuous or inappropriate use of all topical corticosteroids

Answer 8

there is a risk of topical steroid withdrawal reactions

• can result in the development of rebound flares + reported as dermatitis with intense redness, stinging, and burning that can spread beyond the initial treatment area
• use lowest potency needed for shortest time

Question 9

what are the contraindications for all SYSTEMIC corticosteroids

Answer 9

• Avoid injections containing benzyl alcohol in neonates (in neonates)
• avoid live virus vaccines in those receiving immunosuppressive doses (serum antibody response diminished)
• systemic infection (unless specific therapy given)

Question 10

what are the contraindications for all TOPICAL corticosteroids

Answer 10

• Acne
• potent corticosteroids in widespread plaque psoriasis
• rosacea
• untreated bacterial, fungal or viral skin lesions

Question 11

why must you avoid abrupt withdrawal of corticosteroids after prolonged use

Answer 11

Abrupt withdrawal after a prolonged period can lead to acute adrenal insufficiency, hypotension, or death

• adrenal atrophy develops after prolonged corticosteroid and can persist for years after stopping
• note: adrenal atrophy is with all forms of administration but particularly systemic. if a patient get a significant illness/trauma/ surgical procedure, need to temporary increase dose of corticosteroid *

Question 12

how may infections change in a patient who has been using corticosteroids for a long time

Answer 12

• increased risk to infections and severity of infections
• clinical presentation of infections may also be atypical

note this is due to suppressed immune system

Question 13

which patients taking corticosteroids need a varicella–zoster immunoglobulin vaccine

Answer 13

patients who have used corticosteroids within 3 months + not immune to chickenpox

this is because patients receiving oral or parenteral corticosteroids are at risk of severe chickenpox

• note rash is not necessarily a prominent feature of this chicken pox. symptoms are pneumonia, hepatitis and disseminated intravascular coagulation.*

Question 14

what should happen if a patient taking oral or parenteral corticosteroids has a confirmed case of chickenpox

Answer 14

need specialist care and urgent treatment

• Corticosteroids should not be stopped and dosage may need to be increased.

Question 15

what do patients taking corticosteroids need to avoid exposure to

Answer 15

measles (and chicken pox)

Question 16

what are the symptoms of psychiatric reactions that can happen if a patient is taking systemic corticosteroids (particularly high doses)

Answer 16

symptoms of psychiatric reactions: euphoria, insomnia, irritability, mood lability, suicidal thoughts, psychotic reactions, and behavioural disturbances

• reactions frequently subside on reducing the dose or discontinuing the corticosteroid

Question 17

when is gradual withdrawal of systemic corticosteroids needed

Answer 17

gradual withdrawal needed for patients whose disease is unlikely to relapse and have:

• received more than 40 mg prednisolone (or equivalent) daily for more than 1 week
• been given repeat doses in the evening
• received more than 3 weeks’ treatment
• recently received repeated courses (particularly if taken for longer than 3 weeks);
• taken a short course within 1 year of stopping long-term therapy
• other possible causes of adrenal suppression

Question 18

when may it be ok to stop corticosteroids abruptly

Answer 18

ok to withdrawal corticosteroids abruptly if:

if disease is unlikely to relapse + patient received treatment for 3 weeks or less

this is only for patients who are not included in the patient groups which need gradual withdrawal

Question 19

what are the indications for corticosteroids

Answer 19

may indications such as:

• Suppression of inflammatory and allergic disorders
• congenital adrenal hyperplasia
• rheumatoid arthritis
• immunosuppression
• Ulcerative colitis, Crohn’s disease
• asthma/ exacerbation of COPD

Question 20

which corticosteroid has very high mineralocorticoid activity and insignificant glucocorticoid activity

Answer 20

Fludrocortisone

Question 21

which corticosteroid has has equal glucocorticoid and mineralocorticoid activity

Answer 21

Hydrocortisone

Question 22

which corticosteroid exerts predominantly glucocorticoid effects with minimal mineralocorticoid effects

Answer 22

Prednisolone