Steroids

Question 1

When to withdraw slowly?

Answer 1

> 40mg OD for >1 week

Repeated doses in the evening

> 3 weeks treatment

Short course within one year of stopping long term therapy

Other possible causes of adrenal suppression.

Question 2

What can abrupt steroid withdrawal cause?

Answer 2

Adrenal insufficiency
Hypotension or DEATH!

Also: fever, myalgia, arthralgia, rhinitis, conjunctivitis, itchy/painful skin nodules, weight loss.

Question 3

How to withdraw?

Answer 3

Can withdraw rapidly to physiological levels of ~7.5mg prednisolone OD - then reduce more slowly.

Only withdraw if disease unlikely to relapse.

Question 4

Mineralocorticoid side effects ?

Drugs?

Answer 4

HTN
Na+ and H2O retention
K+ loss
Ca2+ loss

Fludrocortisone - most marked effects

Hydrocortisone, corticotropin, tetracosactide also significant effects

Question 5

Corticosteroid side effects?

Drugs?

Answer 5

DM 
Osteoporosis (elderly at most risk) 
High doses - avascular necrosis femoral head
Muscle wasting
Peptic ulcer/perforation (weak link) 
Psychotic reactions 

Betamethasone and dexamethasone most marked effects

Methylpred, pred, triamcinolone mostly glucocorticoid

Question 6

Patient/carer advice ?

Answer 6

Immunosuppression
(Chicken pox/shingles/measles)

Adrenal suppression - not to stop abruptly long term

Mood and behaviour changes possible

Provide steroid card to patient - dose, duration, indication, prescriber and safety information

Question 7

Topical steroids - single application daily for an adult for 2 weeks.

What is 15-30g suitable for?

Answer 7

Face and neck

Both hands

Scalp

Groin and genitalia

Question 8

Topical steroids - single application daily for an adult for 2 weeks.

What is 30-60g suitable for?

Answer 8

Both arms

Question 9

Topical steroids - single application daily for an adult for 2 weeks.

What is 100g suitable for ?

Answer 9

Both legs

Trunk

Question 10

Steroids available as OTC topical products?

Answer 10

Hydrocortisone 1% - 10+ years. Max duration: 1 week. Max 15g per sale. Not for use on face/anogenital region/broken or infected skin. OD-BD use. (Bites/stings - 2-3 days max use)

ClobetaSONE 0.05% - Eumovate
12+. Rest of rules same as above. OD-BD use.

BeCLOmetasone 0.025% - 50mcg/dose nasal spray. Prevention and treatment of allergic rhinitis and other hayfever symptoms. 18+. 2 sprays each nostril BD. 7-14 days before seeking medical advice.

Question 11

Mild potency topical corticosteroid?

Answer 11

Hydrocortisone 0.1-2.5%

Question 12

Moderate potency topical corticosteroid ?

Answer 12

BeTAmethasone 0.025% - Betnovate RD (POM)

ClobetaSONE 0.05% - Eumovate (P)

Question 13

Potent topical corticosteroid?

Answer 13

BeCLOmetasone 0.025%
(Beconase nasal spray) (P/GSL)

BeTAmethasone 0.1% (POM)

Mometasone 0.1% (Elocon/Nasonex) (POM)

Hydrocortisone BUTYRATE 0.1% (Locoid) (POM) not just standard HC

Question 14

Very potent topical steroid?

Answer 14

ClobetaSOL 0.0525% - (Dermovate) (POM)

Question 15

Prednisolone low dose for up to 4 years can be used for what?

Answer 15

Preventing the rate of joint destruction in rheumatoid arthritis.

Keep dose below 7.5mg

Evidence supports the anti-erosive dose for up to 4 years only. Taper off after this to prevent long term ADR’s

Question 16

What are intra-articular steroid injections used for in rheumatoid arthritis ?

Answer 16

To relieve pain

To increase mobility

To reduce deformity in one or more joints

Symptomatic relief

Whilst waiting for DMARD to take effect.

Question 17

Where shouldn’t intra-articular injections be used?

Answer 17

Infected areas

Question 18

Steroid usually used for local injections?

Answer 18

Hydrocortisone acetate

Question 19

Frequency of intra-articular injections?

Answer 19

No more than 4x in each joint per year.