Corticosteroids Flashcards
(24 cards)
What are the broad therapeutic categories for systemic glucocorticoid use?
- Physiological replacement (Addison disease, congenital adrenal hyperplasia, adrenal crisis).
- Anti‑inflammatory / anti‑allergic (asthma exacerbation, anaphylaxis adjunct, urticaria, contact dermatitis).
- Immunosuppression for autoimmune disorders (SLE, RA, nephrotic syndrome, IBD, vasculitis).
- Prevention / treatment of transplant rejection.
- Oncology & haematology (ALL, CLL, lymphoma protocols, symptomatic brain metastasis oedema, appetite stimulation).
- Endocrine & metabolic emergencies (thyroid storm, hypercalcaemia of malignancy).
- Obstetric & neonatal (antenatal lung maturation with betamethasone).
List three life‑saving emergency indications for high‑dose systemic glucocorticoids.
• Acute adrenal insufficiency (hydrocortisone 100mg IV).
• Status asthmaticus unresponsive to bronchodilators.
• Cerebral oedema (dexamethasone).
Other examples: anaphylactic shock, severe septic shock with adrenal insufficiency, acute transplant rejection.
Which glucocorticoid regimen is used for fetal lung maturation?
Betamethasone 12mg IM followed by a second 12mg dose 24hours later, ideally before 34weeks’ gestation.
Describe the genomic mechanism by which glucocorticoids suppress inflammation.
Glucocorticoid→GR complex translocates to nucleus, binds GREs, ↑ transcription of anti‑inflammatory proteins (lipocortin‑1, IL‑10) and represses NF‑κB / AP‑1, ↓ IL‑1, TNF‑α, COX‑2, iNOS.
How do glucocorticoids inhibit the arachidonic‑acid cascade?
They induce lipocortin‑1, which blocks phospholipase‑A₂, thereby preventing release of arachidonic acid and downstream prostaglandins and leukotrienes.
What effects do glucocorticoids have on leukocyte trafficking?
Reduce expression of adhesion molecules → neutrophils demarginate but cannot migrate; lymphocytes, monocytes and eosinophils leave the circulation via apoptosis or redistribution → lymphopenia and eosinopenia.
Enumerate at least five common metabolic or endocrine adverse effects of long‑term systemic glucocorticoids.
• Cushingoid habitus (moon face, buffalo hump).
• Hyperglycaemia / steroid‑induced diabetes.
• Muscle wasting & negative nitrogen balance.
• Osteoporosis & fractures.
• Growth retardation in children.
Name three cardiovascular or electrolyte adverse effects of systemic glucocorticoids.
Hypertension, fluid retention/oedema, hypokalaemic metabolic alkalosis (esp. with mineralocorticoid activity).
What ocular complications are associated with prolonged glucocorticoid therapy?
Posterior sub‑capsular cataract and open‑angle glaucoma (steroid responders).
Outline at least five strategies to minimise adverse effects of systemic glucocorticoids.
• Prescribe the lowest effective dose for the shortest duration.
• Single morning dose mimicking circadian rhythm; consider alternate‑day dosing.
• Add Ca 1g + Vit D 800 IU daily and bisphosphonate if ≥7.5mg pred ≥3months.
• Co‑prescribe PPI in ulcer‑prone patients; avoid NSAIDs.
• Screen for latent TB, update vaccines before high‑dose therapy, PJP prophylaxis ≥20 mg pred >1month.
When and how should systemic glucocorticoids be tapered?
After >2 weeks of ≥10 mg pred‑equivalent daily, taper slowly: reduce by 10–20 % every 1–2 weeks, monitor for adrenal insufficiency; stop when morning cortisol is adequate (>10 µg/dL).
Explain the concept of ‘stress dosing’ for patients on chronic glucocorticoids.
During major surgery, trauma or severe illness, double or triple the daily glucocorticoid dose to mimic the normal cortisol surge and prevent adrenal crisis.
Classify topical corticosteroids by potency with one example each.
Super‑potent: Clobetasol propionate0.05 %.
High: Betamethasone dipropionate0.05 %.
Moderate: Triamcinolone acetonide0.1 %.
Mild: Hydrocortisone acetate1 %.
State three dermatological conditions where topical steroids are first‑line therapy.
Atopic eczema, seborrhoeic dermatitis, limited plaque psoriasis.
List four local adverse effects of chronic potent topical steroid use.
Skin atrophy, telangiectasia, striae, hypopigmentation, perioral dermatitis.
Give two practical rules that minimise systemic absorption of topical steroids.
Use the lowest effective potency for the shortest time; avoid occlusion or large surface‑area application, especially in infants.
Give four commonly used inhaled corticosteroids.
Budesonide, Fluticasone propionate, Beclomethasone dipropionate, Ciclesonide.
Why are inhaled corticosteroids considered ‘controller’ drugs in asthma?
They suppress chronic airway inflammation, reduce eosinophils and cytokines, improve β₂‑agonist responsiveness and prevent structural airway remodelling.
What two simple measures reduce the risk of oropharyngeal candidiasis with ICS?
Use a spacer device with pressurised MDI and rinse the mouth or gargle with water after inhalation.
Why is prednisolone preferred over dexamethasone for maintenance therapy in Addison’s disease?
Prednisolone’s intermediate half‑life (12–36 h) allows physiologic twice‑daily dosing and provides slight mineralocorticoid activity, whereas dexamethasone is very long‑acting and 25× more potent, causing prolonged HPA suppression and lacks mineralocorticoid effect.
Why is administration of glucocorticoids contraindicated in untreated active infection?
They impair innate and adaptive immunity, mask fever and inflammation, and permit rapid dissemination of pathogens such as TB, Strongyloides or fungal infections unless effective antimicrobials are given.
Which vaccinations are contraindicated during high‑dose systemic glucocorticoid therapy?
Live vaccines (MMR, varicella, yellow fever, intranasal influenza) should be deferred until ≥1 month after stopping or reducing to physiologic dose.
Outline a monitoring schedule for a patient starting ≥10 mg prednisolone for ≥3months.
Baseline: weight, BP, fasting glucose, lipids, DEXA scan, TB screening.
Every visit: BP, weight, glucose.
3‑6 monthly: DEXA if osteoporotic risk, lipid profile.
Annual: cataract/glaucoma check, growth chart in children.
Give two pharmacological measures to protect bone health in long‑term steroid users.
Calcium 1000–1500mg plus vitamin D 800–1000 IU daily, and oral bisphosphonate (alendronate 70 mg once weekly) for adults on ≥7.5 mg pred ≥3 months.
