Iatrogenic Complications of Steroid Treatments Flashcards Preview

MD1 Endocrine > Iatrogenic Complications of Steroid Treatments > Flashcards

Flashcards in Iatrogenic Complications of Steroid Treatments Deck (36):
1

What are some iatrogenic complications of glucocorticoid therapy?

Cushingoid syndrome
Adrenal suppression
Immunosuppression
Peptic ulcers
Osteoporosis
Inhibition of linear growth in children

2

Why do you get adrenal suppression with glucocorticoid therapy?

Cortisol not released > cells atrophy > can't produce cortisol anymore

3

Does everyone with Addison's disease get a tan in the absence of sunlight?

No
Can also just get patchy discolouration

4

Why are people who present with cortisol deficiency often missed?

Nebulous symptoms
Gradual onset
Each patient present differently

5

What also occurs with a cortisol deficiency in primary adrenal hypofunction?

Mineralocorticoid deficiency

6

What does a mineralocorticoid deficiency present as?

Hyperkalaemia
Hyponatraemia
Acidosis
Dehydration

7

Why is it so important to diagnose Addison's disease promptly?

Death follows quickly

8

What are the options for cortisol replacement?

Hydrocortisone
Cortisone acetate
Prednisolone

9

How is replacement cortisol dosed?

Divide dose to mimic physiological time course
- Large dose in morning
- Smaller dose during day

10

When are extra doses of replacement cortisol taken?

Infections
Periods of stress

11

What must be done for patients when they're put on cortisol replacement therapy?

Have to be educated to adjust dose themselves

12

Why is extra cortisol needed during infections?

Stop over-activation of immune system

13

Does everyone with Addison's disease require fludrocortisone?

No, but most do

14

What is the bioavailability of oral cortisone?

A little less than cortisol's

15

Are there any side effects with cortisol replacements?

No, if it's well-managed physiological replacement

16

Why do some patients prefer to use prednisolone rather than hydrocortisone or cortisone?

Prednisolone has longer half life

17

What happens to cortisol in the kidneys?

Quickly converted to cortisone

18

Why is cortisol so quickly inactivated in the kidneys?

Prevent it acting on mineralocorticoid receptor

19

What happens to cortisone in the liver?

Reconverted to cortisol via same enzyme as that in kidney

20

What is the half life of prednisolone?

Prednisone's half life = 1 hour
Converted to prednisolone
Prednisolone's half life = 3-4 hours

21

When do cortisol peaks occur?

With meal times

22

Why don't patients take cortisol with each meal?

Can't mimic short lived peaks
Therefore take big dose in morning and smaller dose later in evening

23

What is the major complication of glucocorticoid therapy?

Adrenal suppression

24

What is adrenal suppression because glucocorticoid therapy related to?

Dose and duration
- Varies between drugs
- Affected by dosing regime

25

Do patients all react to adrenal suppression in the same way?

No, varies in severity and duration

26

How do you minimise adrenal suppression?

Allow for ACTH secretion
- Avoid long-lasting drugs
- Alternate day dosing
- Morning dose > most effectively mimics diurnal system
Minimise systemic absorption
- Inhaled/topical
3rd generation glucocorticoid drugs

27

What is ciclesonide?

3rd generation glucocorticoid

28

Why does ciclesonide have reduced systemic effects after inhalation?

Pro-drug activated in lungs
Lipophilic > retained in tissue
Low oral bioavailability
Highly protein bound in plasma

29

Do glucocorticoids cause peptic ulcers?

Causal role debatable
Mostly occur in patients taking NSAIDs
- Synergistic interaction possible

30

What does RANK on osteoclast precursors bind to?

RANKL

31

What does binding of RANK and RANKL do?

Promotes osteoclast formation

32

What do osteoclasts do?

Promote bone resorption

33

What does OPG do to osteoclasts?

Inhibits their formation by binding to RANKL

34

What is the effect of glucocorticoids on RANKL and OPG?

Increase RANKL
Decrease OPG

35

Do glucocorticoids cause osteoporosis?

Do get some bone resorption but benefit of treating asthma may be greater

36

Do glucocorticoids inhibit linear growth in children?

Modest effect size with moderate dosing
May be less than disease-induced stunting