CORTICOSTEROIDS

Question 1

Corticosteroid - side effects

Answer 1

Cushing’s syndrome
Osteoporosis
Retardation of growth
Thin skin
Immunosuppression + Insomnia
Chorioretinopathy
Oedema (water retention)
Striae
Emotional disturbance
Rise in BP (hypertension)
Obesity (truncal)
Increased hair growth (hirsutism)
Diabetes mellitus (hyperglycemia)

Ulcers (peptic)
Suppression (adrenal)
Electrolyte imbalance (hypokalaemia)

Question 2

MHRA/CHM advice: Central serous chorioretinopathy

Answer 2

Report blurred vision or other visual disturbances

Question 3

Psychiatric reactions

Answer 3

• Insomnia, irritability, mood change, suicidal thoughts and behavioral disturbances
• Seek medical advice and withdraw treatment

Question 4

Adrenal suppression + corticosteroids

Answer 4

• Prolonged used can lead to adrenal atrophy (can last years after treatment ends)
• Abrupt withdrawal = acute adrenal insufficiency, hypotension or death
• Significant illness, trauma, or surgical procedure = temporary increase in corticosteroid dose, or temporary reintroduction if already stopped

Question 5

Abrupt withdrawal of corticosteroids in adrenal suppression

Answer 5

Abrupt withdrawal = acute adrenal insufficiency, hypotension or death

Question 6

Significant illness, trauma, or surgical procedure in adrenal suppression

Answer 6

temporary increase in corticosteroid dose, or temporary reintroduction if already stopped

Question 7

Infection

Answer 7

Infections (due to immunosuppression)
* Serious infections may reach an advanced stage before being recognised

Question 8

Chickenpox

Answer 8

• Risk of severe chickenpox unless patient developed immunity
• Passive immunisation with varicella-zoster immunoglobulin needed for exposed non-immune patients
• Confirmed chickenpox warrants specialist care and urgent treatment

Question 9

Measles

Answer 9

• Prophylaxis with IM normal immunoglobulin may be needed
• Seek immediate medical advice if exposure occurs

Question 10

Insomnia

Answer 10

Take steroids as one dose in the morning
Due to sleep disturbances

Question 11

Steroids side effects in children

Answer 11

Stunted growth
Even with ICS

Question 12

Skin thinning

Answer 12

Most common in topical
Apply thinly

Question 13

Cushing’s Syndrome

Answer 13

Prolonged use
Moon face, striae, hirsutism and acne
Managed with metyrapone, treated with ketoconazole

Question 14

Managing SEs

Answer 14

• Lowest effective dose for minimum period
• Give as a single dose in the morning
• Total dose for two days can be taken as a single dose on alternate days
• Intermittent therapy with short courses
• Local treatment rather than systemic
• E.g. Creams, intra-articular injections, inhalations, eye-drops, or enemas

Question 15

Gradually withdraw from steroids if

Answer 15

• More than 40 mg prednisolone (or equivalent) daily for > 1 week
• Repeat evening doses
• > 3 weeks treatment
• Recently received repeated courses
• Taken a short course within 1 year of stopping long-term therapy
• Other possible causes of adrenal suppression.
• All entitled patients to be given a steroid card

Question 16

Topical steroid potencies

Answer 16

Mild: Hydrocortisone
Moderate: Clobetatone
Potent: Betamethasone
Very Potent: Clobetasol

Question 17

Dexamethasone

Answer 17

Used in palliative care.
Anti-inflammatory (reduces swelling/inflammation caused by tumour)
Appetite stimulation (prevents weight loss in those with anorexia due to the cancer)
N + V (particularly when it is caused by increase intracranial pressure/chemo regime)

Question 18

Hydrocortisone

Answer 18

Surgery
Emergencies e.g. anaphylaxis

Question 19

Fludrocortisone

Answer 19

Postural hypotension

Question 20

Prednisolone

Answer 20

Asthma
COPD
IBD
Severe eczema