Mineralocorticoid steroid-
- High fluid retention,low anti inflammatory effect
- Highest mineralocorticoid steroid activity =fludrocortisone
- Hydrocortisone - also high activity
- Fludrocorticoid steroid used to treat postural hypotension
Mineralocorticoid steroid side effects
- Sodium and water retention = hypertension
- Potassium loss = hypokalaemia
- Calcium loss = hypocalcaemia
Mineralocorticoid effects are negligible with high potency glucocorticoid -betamethasone and dexamethasone
Glucocorticoid steroid:
High anti inflammatory effects,low fluid retention
Highest glucocorticoid steroid activity = dexamethasone/betamethasone
- Prednisolone,prednisone,deflazacort also have high activity
Side effects
Glucocoids
Diabetes
Osteoporosis- osteoporotic fractures
Avascular necrosis of the femoral head and muscle wasting
Gastric ulceration and perforation
ALL CORTICOSTEROID SIDE EFFECTS:
Mhra advice???
MHRA/CHM advice: Central serous chorioretinopathy
- Report blurred vision or other visual disturbances
Psychiatric reactions:
- Insomnia,irritability,mood change,suicidal thoughts and behavioural disturbances
- Seek medical advice and withdraw treatment
Adrenal suppression -
Can lead to what kind of atrophy? Abrupt withdrawal causes what? Significant illness or trauma can cause what? What happens with surgery or trauma
-Prolonged use 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
Infections due to immunosuppression? What do we do?
Infections - due to immunosuppression
- Serious infection may reach an advanced stage before being recognised
- Chicken pox:
- Risk of severe chickenpox unless patient developed immunity
- Passive immunisation with varicella- zoster immunoglobulin needed for exposed non immune patients
- Confirmed chickenpox warrants specialist and urgent care
Measles:
- Prophylaxis with intramuscular normal immunoglobulin may be needed
- Seek immediate medical advice if exposure occurs
Insomnia- steroid should be taken in….
Height,skin,moon what can we treat it with?
- Take steroid as one dose in the morning (when cortisol is produced)
- Children: stunned growth even with inhaled corticosteroid
- Skin thinning - most common in topical admin
- Prolonged use can lead to Cushing’s syndrome
- = moon face,striae,hirsutism and acne
- Managed with metyrapone,treated with ketoconazole
CORTICOSTEROID SE
Crushing syndrom
Osteoporosis
Retardation of growth
Thin skin
Immunosupression and insomnia
Chorioretinopathy
Odema
Striae
Emotional disturbance
Rise in BP - hypertension
Obesity - truncal
Increased hair growth - Hirsutism
Diabetes Mellitus
Ulcers peptic
Suppression - adrenal
Electrolyte imbalance - hypokalaemia
Managing side effects:
Lowest dose for how long? Give a single dose when? Total dose for two days can be taken when? Intermittent therapy with what?
- Lowest effective dose for minimum period
- Give 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 rather than systemic
Gradually withdraw if…
- More than 40mg prednisolone (or equivalent) daily for more than 1 week
- Repeat evening doses
- Treatment for longer than 3 weeks
- Recently received repeated courses within 1 year old stopping log term therapy
- Other possible causes of adrenal suppression
- All entitled patients to be given a steroid card
Topical steroid
Rd - diluted
Topical steroid scale
Mild - Hydrocortisone
Moderate- Clobetasone
Potent - betamethasone
Very potent - clobetasol
Adrenal insufficiency - cause by Addison’s disease or congenital adrenal hyperplasia
What do we treat it with??? What can primary adrenal insufficiency be treated with? What can adrenal crisi lead to ?
Treat with- hydrocortisone
- Primary adrenal insufficiency treated with fludrocortisone as well
- Can lead to adrenal crisis - severe dehydration,hypovolaemic shock, altered consciousness,severe seizures,stroke or cardiac arrest - death if untreated
- Medical emergency - treat with hydrocortisone
