glucocorticoid steroids
high anti inflammatory effect
low fluid retention
- highest activity - dexamethasone, betamethasone
—- prednisolone, prednisone and deflazacort also has high activity
preferred when fluid retention may be disadvantageous
glucocorticoid effect
diabetes
osteoprosis - osteoporotic fractures
avascular necrosis of femoral head and muscle waisting
gastric ulceration and preforation
mineralocorticoid
high fluid retention
low anti inflammatory effect
highest activity - fludrocorticortisone
hydrocortisone also
fludocortisone - treat postural hypotension
mineralocorticoid
sodium and water retention - hypert
potassium loss - hypoK
calcium loss - hypoCal
mineralocorticoid effects are neglible with the high potency glucocorticoids betamethasone and dexamethasone
MHRA warnings - cortico
early psychiatric side effects
- seek urgent medical attention: irritability, mania, depression, anxeity, sleeping disorders, suicidal thoughts
central serous chorioretinopathy
- occurs in local treatments as well as systemic admin
- one eye
- vision blurry to distorted
side effects
adrenocortical insufficiency
- prolonged used can lead to secondary adrenocortical insufficiency
- abrupt withdrawal - acute adrenal insufficiency - FATAL
- ILLNESS, TRAUMA, SURGICAL PROCEDURE - temp. increase dose or reintroduce if recently stop
infection - immunosuppression
- increases susceptibility to infections and increases their severity
- infections may be masked reach advanced stage before being recognised
chickenpox
- may be fatal in immunosuppressed
- avoid with chicken or herpes zoster - exp= urgent
- passive immunisation v zoster immunoglobulin in exposed non-immunised patients
measles
- urgent medical
- prophylaxis with IM normal immunoglobulin
LIVE vaccines
- DO not administer
- postpone - at least 3 mnths after stopping therapy
cushing’s disease
- avoid in patients with cusings - can aggrivate
- use can lead to cushing’s - moon face, striae, hirsutism and acne
raised intracranial pressure
- onset usually occurs after treamtent withdrawa
side effects
chorioretinopathy
hypokalaemia
stunned growth - even inhaled
peptic ulcers
obesity
cushing’s syndrome
adrenal supression
hypertension
isnomina - in monring
striae
emotionsl disturbances
oedema
skin thinning - topical
osteoporosis
managing side effects
lowest effective dose for minimum time possible
single dose in morning -mimics natural
total dose in 2 days can be taken as single dose on alternate days
intermittent therapy with short courses
PPI
local rather than systemic
give patients a steroid card
pregnancy and BF
pregnancy
- can be used if benefits outweight risk
monitor mother fluid retention
BF
- unlikely to have systemic effects on infant
- avoid prolonged high dose therapy- minimise risk of adrenal suppression in infant
- monitor infants for adrenal insufficiency
- try to wait 4 hrs between dose and BF
monitoring
before starting
- blood pressure, weight, BMI, height
- HBA1C or fasting glucose level, triglycerides, potassium
- optometrist assessment for glaucoma and cataract
during treatment
- blood pressure, triglycerides, HBA1c, body weight, height
- osteoporosis, falls risk, adrenal suppression
- eye disorders
gradually reduced dose
short courses of oral corticosteroids - less than 3 weeks can be stopped abruptly
- more than 40mg pred or equiv daily for >1 week
- repeat evening doses
- over 3 weeks treatment
- recently recieved repeated courses
- having previous long term therapy in past mnths or years
- other possible causes of adrenal supression, excessive alcohol or stress
potencies
mild- hydrocortisone
mod - clobetasone
potent - betamethasone
very potent - clobetasol
