Steroid responsive conditions Flashcards
(23 cards)
Which drugs are licensed to treat Cushing’s syndrome?
Ketoconazole and Metyrapone
Treatment for Primary adrenal insufficiency?
Both mineralcorticosteroids and glucocorticosteroids
What disease shares a name with Primary adrenal insufficiency
Addison’s disease
What hormone does mineralcorticosteroids affect?
Aldosterone
Treatment for secondary adrenal insufficiency?
Glucocorticosteroids only
Which glucocorticosteroids would be best used if wanting to avoid water retntion?
Dexamethasone and betamethasone
Which steroid has equal glucocorticoid and mineralcorticoid activity?
Hydrocortisone
How is cushing’s syndrome diagnosed?
Overnight dexamethasone suppression test
Why is hydrocortisone not used long-term in inflammatory conditions?
Serious side effects including water retention
Common side effects of glucocoroticoid steroid use
Hyperglycaemia, osteoporosis, GI disturbances, skin thinning/bruising, weight gain, gluacoma and cataracts, psychiatric conditions, cushing’s syndrome
Common side effects of mineralcorticoid steroids
Water and sodium retention, hypertension, loss of potassium and calcium
What time of administration do glucocorticoids have the greatest effect on HPA axis suppression?
At night
Why are glucocorticoid steroids best given in the morning?
They can cause insomnia
Symptoms of adrenal insufficiency
Fatigue/ lethargy, Muscle weakness, Low mood/depression, Loss of appetite/weight loss., Urinary frequency, Increased thirst,
Craving salty foods.
Action taken by those on glucocorticoid replacement therapy when undergoing stress such as invasive surgery or trauma?
Steroid doses should be increased/ stress doses given
Action taken by those on glucocorticoid replacement therapy when undergoing antibacterial treatment for infection or fever present?
Sick day rules should be followed- steroid doses doubled
Action to be taken if a patient is on a long-acting hydrocortisone preparation and they become ill?
Should be swapped to short-acting preparation that is more readily absorbed.
Name the longer duration steroids
Betamethsone and Dexamethasone
Name the shorter duration steroids
Hydrocortisone
Name the intermediate acting steroids
Prednisolone, methylprednisolone, Fludrocortisone, prednisone
MHRA alert for systemic and local use of corticosteroids
Central serous chorioretinopathy
When can steroids be stopped abruptly?
<4 weeks course
When should abrupt withdrawal of steroids be avoided?
If taken 40mg prednisolone or equivalent >1 week
If taken repeated evening doses
>4 weeks of steroid treatment
History of long-term steroids (months-years)
If repeated short courses
Additional factors affecting adrenal suppression e.g., excessive alcohol or stress.
