steroids

Question 1

what is the MHRA warning side efffect associated with corticosteroids associated with all of its forms

Answer 1

chorioretinopathy
retinal disorder with local and systemic use
recently been reported through use of local admin routes- inhalation, intranasal, topical, epidural
report any blurred vision or visual disturbance
refer to opthalmogist

Question 2

what is mineralocorticoid activity?

which steroid hs the most mineralcorticod activity

Answer 2

works on water and electrolytes balance- holds water in body whihchraises blood pressure so it used in ppl with lower bp
fludrocortisone

Question 3

what is glucocorticoid activity?

Answer 3

anti-inflammatory/ reduce immune repsonse

Question 4

example of a steroid that has both glucocoticoid and mineralcorticoidactivity

Answer 4

Hydrocortisone

Question 5

example of glucocorticoid steroids

Answer 5

dexa

pred

Question 6

Side effect of gluticosteroids

diabetic bodybuilders are psychos and get stomach ulcers from eating broken bones

Answer 6

cushings sydrome
moon face
Hyperglycaemia 
Osteoporosis esp in eldely
muscle wasting- myopathy
peptic ulceration/perforation
psychiatric reactions

Question 7

what are the side effects of mineralcorticoid side effects

memory trick: water retention, Na retention, hypertension

Answer 7

Hypertensionsodium retention
water retention
potassium loss
calcium loss
occurs most with fludrocortisone
least seen with betamethasone and dexametasone due to their high glucocorticoid potency

Question 8

what is adrenal suppression?

what is it caused by the majority of the time

Answer 8

adrenal glands do not produce adequate amounts of cortocisteroids primarily cortisol and the mineralcorticoid aldosterone which regullates Na and K and water retention
addisons disease

Question 9

which hormones are secreted by the adrenal cortex and regulate NA and K and water balance

Answer 9

aldosterone

cortisol

Question 10

what is the difference between addisons and cushings disease
crushing
adding

Answer 10

cushings- too much steroid

addisons- too little steroid

Question 11

what are teh symptoms of addisons disease

Answer 11

salt craving because it causes hypernatraemia
hyponatraemia
Hypoglycaemia 
weight loss\hyperkalemia
hypotension
n and v
anorexia
fatigue

Question 12

how do we minimise corticosteroids side effects

Answer 12

lowest dose for shortest time
in Morning single dose
local treatment rather than systemic
large volume spacer devices if higher doses required

Question 13

how is adrenal deficiency treated

Answer 13

physiological replacement- combo of hydrocortsione and fludrocortisone- it mimics the bodys natural steroids
provides fludrocrtisone which is aldosterone (a mineralcoticosteroid) and cortisol from hydrsotisone which is a glucocorticoid

Question 14

which steroid has the highest and second highest glucocorticoid actvitvity
when are they appropriate to use

Answer 14

beclometasone
dexametasone
long duration of action
siutable for therapies where fluid retention is not required

Question 15

high glucocorticoid activity needs minimal mineralcorticoids

Answer 15

high glucocoticoid activity only benefit as long as it is accompanied by low mineralcorticoid activity
(this means anti-inflammation therapy with these drugs only works when there is minimal activity trying to retain water such as fludrocotisone

Question 16

what are the s/e increased risks due to of systemic steroids

Answer 16

Blurred vision/disturbance
adrenal suppression- using for a long time, abrupt withdrawal
infection- reduce immune system so increased risk of infectsions
psychiatruc reactions- seek gp to reduce
chicken pox unless they have alrady head - eledlry will have vaccine
measles- avoid exposure

Question 17

can steroids be used in preganancy

Answer 17

benefit ouutweighs the risk

Question 18

when dom you reduce steroids gradually compard to abruptly

Answer 18

Gradual withdrawal for patienst whose disease is unlikely to relapse and have
recieved more than 40mg pred or equivalent daily for overr a week
had repeat doses in evening
recently recieved repeat course esp if for over 3 weeks
taken short course within year of long course
more than 3 weeks treatment
other causes of adrenal suppression

Question 19

what is hyperthroidism characterised by

Answer 19

too much thyroxine (t4)/ t3 which is the inactive form

low TSH

Question 20

symptoms of hyperthyoidism

Answer 20

goitre
disturbed sleep
hyperactivity
heat intolerance
unintentional weight loss
complications- thyroid storm, preganancy complications, HF, AF, reduced bone mineral density

Question 21

drugs to treat hyperthyroidism

Answer 21

used to either prepare pts for thyroidectomy or long term management
carbimazole
propylthiouracil
both interefere with synthesis of thyroid hormones

Question 22

what is the blocking replacement regimen

for which type of pts can’t use this therapy

Answer 22

mixture of carbimazole and levothyroxine so pt isnt hypo or hyperthoidism- balance
pregnancy

Question 23

antithyroid drugs that are not carbimazole or propylthiouracil

Answer 23

iodine- adjunct antithyroid drugs avoid long term
radioactive sodium iodide: treatment of thyrotoxicosis
Propanolol: reliefs thyrototoxic symptoms- can be used in conjuction with iodine

Question 24

what is thyrotoxic crisis (thyroid storm)

how is it treated

Answer 24

medical emergency- rapid hr, temp, loss of consciouseness, jaundice, vomiting
I.V fluids
propanolol- blocks conversion of t4 to active form t3
hydrocotisone
oralniodine, carbimazole, propyluthiouracil

Question 25

which antihyperthyroid drugs can be used in pregnancy in a thyroid storm- which trimester

Answer 25

cross the placenta and can cause fetal goitre and hypothyroidism 1st trimester: propylthiouracil not later because it can destroy liver 2nd/3rd trimester: carbimazole and no earlier becuase it can cause brain damage

Question 26

important safety advice with carbimazole

Answer 26

neutropenia and agranulocytosis bone marrow suppression- stop treatment immediately report signs of infections- esp sore throat WBC at any sign of infection stop promptly at any sign of infection

Question 27

what the counselling advice to give with carbimazole

Answer 27

tell dr immediately if sore throat, mouth ulcers, bruising, fever, malaise or non specific illness develops

Question 28

MHRA Advice for carbimazole

Answer 28

acute pancreatitis | congenital defects in first trimester

Question 29

monititoring and advice for propylthiouracil

Answer 29

hepatoxcity- pt look out for signs | stop if liver enzyme problems develo0ps

Question 30

what is hypothyroidism

Answer 30

underproduction of Thyroid hormones | high tsh and low t4

Question 31

signs and symptoms of hypothyrodism

Answer 31

``` fatigue weight gain constipation mesntrual irregularities intolerance to col ```

Question 32

hypothydoism causes

Answer 32

``` iodine deficnecy automine radiotherapty surgery drugs pituitary disorder ```

Question 33

hypothyroid drugs

Answer 33

levothryroxine- drug of choice liothyronine- more rapidly metabolised and more rapid effect. used in more severe hypothyroid states when a rapid response is required.- treatment of choice in hyperthyroid coma

Question 34

indications of hypothyroidism drugs

Answer 34

diffuse goitre hypothroidism thyroid carcinoma

Question 35

risk factors of osteoporosis

Answer 35

``` lifestyle early menopause RA Diabetes history of fractures ```

Question 36

medications used in post menopoausal osteoporosis

Answer 36

oral bisphosphonates- alendronic acid and risedronate- both reduce fractures if contraindicated. use ibandronic acid or desunomab or raloxifene HRT- restricetd to younger post menopausal woomen due to cardiovascular risk and cancer

Question 37

treatment for glucocorticosteroid osteoprosis

Answer 37

glucocorticoid cause bone loss- usually when you start treatment prophylaxis is bisphospohonates

Question 38

list line for osteoporosis in men

Answer 38

oral bisphosphonates 1st line | absorb to crystals in the bone to slow down the process of them breaking dow bone turnover

Question 39

mhra for bisphophonates

Answer 39

2 years plus - atypical femoral fracture- pain in hips thigh, groin so need to report to dr osetonecrosis- pain in jaw- not enough blood goes to jaw- need to maintain good oral hygiene. greater with I.V Oseteonecrosis of external auditory canal: report signs of ear pain, discharge from ear or ear infection

Question 40

side effects for alendronic acid

Answer 40

oesophageal reactions- syphagia, heartburn, pain on swallowing, retrosternal pain report to dr immediately

Question 41

counselling for alendronic acid

Answer 41

swallow whole on single 100ml dose taken on empty stomach 30 mins before breakfast or any other oral med sitting or standing with plenty of water sit or stand upright for 30 minutes after taking the dose

Question 42

what is HRT and what is it used for

Answer 42

uses oestrogen and progestrogen to alleviate symptoms of menopause

Question 43

signs of menopause

Answer 43

``` hot flusses vaginal atrophy, dryness bone loss sexual dysgunction decreased muscle mass accelerated skin aging ```

Question 44

what age is early menopuse | what age is natural menopause

Answer 44

less than 45 | greater than 50§

Question 45

which hormonal activity does tibolone exhibit

Answer 45

oestrogenic , progestogenic and androgenic activity

Question 46

when is progestrogen given to women with menopause

Answer 46

women with a uterus on long term therapy to reduce risk of endometrial cancer and cystic hyperplasia

Question 47

which causes throboembolism : oestrogen or progestrogen

Answer 47

oestrogen

Question 48

clonidine indication

Answer 48

menopausal symptoms in women who can't take oestrogen but may cause unacceceptable side effects

Question 49

risks from HRT

Answer 49

Breast cancer wndometrial cancer- risk reduced with progesterogen ovarian cancer VTE stroke CHD Benefit outweighs risk for under 60yr olds moment you stop HRT then the riak reduces

Question 50

risk of breast cancer in HRT

Answer 50

all types of hrt increase the risk off the breast cancer within 1-2 years of initiating treatment risk disappears within 5 years of stopping

Question 51

Risk of endometrial cancer in HRT

Answer 51

Depends on dose ad duration cyclically reduces risk of cancer risk eliminated with progestrogen but higher risk of breast cancer

Question 52

which hrt has high risk of stroke

Answer 52

tibolone increaes risk by 2.2 in first year

Question 53

when can oestrogen be given alone

Answer 53

without a uterus unless in endometreosis where you give progestrogen as well

Question 54

how soon do you need to stop hrt before surgery

Answer 54

stop 4-6 weeks before surgery

Question 55

reasons to stop HRT

Answer 55

``` dvt signs jaundice neurological effects breath;ess stomach pain ```

Question 56

sex hormones ethinylestradiol and raloxifene indications

Answer 56

short term symptoms of oetrogen deficiency osteoporosis prophylaxis female hypogonadism and menstrual disorders raloxifene treatment and prevention of postmenopausal osteoprosis dose not releive menopausal vasomotor symptoms e.g hot flushes

Question 57

testostetone analogues

Answer 57

norethisterone, norgestrel

Question 58

progesterone and analogues

Answer 58

dydrogesterone and medroxyprogesterone