Corticosteroids

Question 1

Hydrocortisone (oral)

1. Drug class
2. Indication
3. Dosage range, Frequency and best admin time
4. Monitoring
5. Counselling

Answer 1

1. Corticosteroid
2. GLUcocorticoid replacement in adrenal insufficiency, acute adrenal insufficiency. Wide range of conditions for anti-inflammatory and immunosuppressant effects (acute severe asthma, autoimmune, inflammatory condition)
3. 0.24mg/kg (usually12-25mg) daily in 2-3 doses, with the majority of the dose in the morning. Eg: 12mg, 4mg or 8mg (8am), 4mg (midday), 4mg (later afternoon).
5. BSLs - ↑ sugar levels, diabetes
6. Potassium – hypokalaemia ↓K+
7. Peptic ulcers – PPI onboard? Longterm
8. BMD – vitamin D, fractures, calcium
9. Psychiatric – mood changes, can be +ve or -ve
10. Infection – more prone to infection, ↑ risk of srs infection
11. Immunocompromised – more prone to catching viruses etc.
12. Adrenal suppression – don’t stop abruptly Label 9
13. Weight gain – possibility of Cushing’s “moon face”, fat redistribution
14. 25mg oral pred = 100mg of IV hydrocortisone
15. Don’t stop abruptly Label 9
    With food to decrease stomach upset
    Morning - may cause problems with sleeping, talk to Dr if any concerns.
    Tell Dr if any signs of infection (redness, swelling, fever, sore throat etc.)
    Mood may be affected, you may feel more happy or more sad than usual.

Question 2

Fludrocortisone

1. Drug class
2. Indication
3. Dosage range, Frequency and best admin time
4. Monitoring
5. Counselling

Answer 2

1. Corticosteroid
2. MINERALcocorticoid replacement in primary adrenal insufficiency w/a glucocorticoid, salt-losing congenital adrenal hyperplasia, w/a glucocorticoid.
   Accepted: orthostatic hypotension
3. Initially 50-100microg OD mane, if necessary increase to 200microg D.
   Orthostatic hypotension: 100microg-200microg if necessary.
4. Titrate dose based on smx.
   BP sitting/standing
   Plasma renin
   Serum Na+ and K+ concs. rentention can occur
5. BSLs - ↑ sugar levels, diabetes
6. Potassium – hypokalaemia ↓K+
7. Peptic ulcers – PPI onboard? Longterm
8. BMD – vitamin D, fractures, calcium
9. Psychiatric – mood changes, can be +ve or -ve
10. Infection – more prone to infection, ↑ risk of srs infection
11. Immunocompromised – more prone to catching viruses etc.
12. Adrenal suppression – don’t stop abruptly Label 9
13. Weight gain – possibility of Cushing’s “moon face”, fat redistribution
14. 25mg oral pred = 100mg of IV hydrocortisone
15. Tell Dr if you develop swelling in the feet or ankles, headaches or weakness.
    Don’t stop abruptly Label 9
    With food to decrease stomach upset
    Morning - may cause problems with sleeping, talk to Dr if any concerns.
    Tell Dr if any signs of infection (redness, swelling, fever, sore throat etc.)
    Mood may be affected, you may feel more happy or more sad than usual.

Question 3

Desmopressin (aka DDAVP)

1. Drug class
2. Indication
3. Dosage range, Frequency and best admin time
4. Monitoring
5. Counselling

Answer 3

1. Antidiuretic hormone analogue
2. Diagnostic aid for differential diagnosis of polyuria, central (cranial) diabetes insipidus, Nocturnal enuresis, Nocturia due to idiopathic nocturnal polyuria, Control of bleeding in patients with mild or moderate haemophilia and type I von Willebrand’s disease (seek specialist advice), Control of bleeding in surgery in people with certain platelet disorders (seek specialist advice)
3. 100-200microg TDS (200microg-1.2mg D)
4. Water balance
   Renal fn
   Na+ conc
5. Tell Dr immediately if you have N&V, headache or weight gain.

Question 4

Prednisolone

FINSIH OFFF

Answer 4

1. Corticosteroid
2. Where corticosteroids are indicated, eg autoimmune or inflammatory disease, acute asthma, COPD exacerbation, acute gout, croup

According to treatment protocol, eg for multiple myeloma, lymphoma, some leukaemias

5. BSLs - ↑ sugar levels, diabetes
6. Potassium – hypokalaemia ↓K+
7. Peptic ulcers – PPI onboard? Longterm
8. BMD – vitamin D, fractures, calcium
9. Psychiatric – mood changes, can be +ve or -ve
10. Infection – more prone to infection, ↑ risk of srs infection
11. Immunocompromised – more prone to catching viruses etc.
12. Adrenal suppression – don’t stop abruptly Label 9
13. Weight gain – possibility of Cushing’s “moon face”, fat redistribution
14. 25mg oral pred = 100mg of IV hydrocortisone
15. Don’t stop abruptly Label 9
    With food to decrease stomach upset
    Morning - may cause problems with sleeping, talk to Dr if any concerns.
    Tell Dr if any signs of infection (redness, swelling, fever, sore throat etc.)
    Mood may be affected, you may feel more happy or more sad than usual.