What are the main effects glucocorticoids have on the body
Carbohydrate, Fat, Protein metabolism Anti-inflammatory properties Immunosuppresive Anti-proliferative Vasoconstrictive effects
What are the main effects of mineralcorticoids like aldosterone
Regulation of electrolyte and water balance
What are the mineral corticoid side effects
Hypertension Sodium Retention Water retention Potassium loss Calcium loss
What are the glucocorticoid side effects
Diabetes Osteoporosis (elderly) Necrosis of femoral head Proximal myopathy Psychiatric reactions Cushing's syndrome Weight gain/ increased appetite
How long is the duration before a patient should receive a steroid card
More than 3 weeks
What are the warning signs to watch out for in steroids
- Paradoxical bronchospasm (constriction of airways)
- Uncontrolled asthma (cough, wheeze, tight chest)
- Adrenal suppression (can lead to hypotension and death, includes fever, nausea, vomiting, weight loss, fatigue, headache, muscular weakness)
- Frequent courses of steroids/antibiotics
- Immunosuppression
- Psychiatric reactions (aggravation of epilepsy or schizophrenia)
When should gradual withdrawal of corticosteroids be considered
Those who have received more than 40mg prednisolone daily for more than one week
Been given repeat evening doses
Received treatment for more than 3 weeks
What should you monitor for in corticosteroid treatment
Blood pressure Blood lipids Serum Potassium Body weight and height in children and adolescents Bone mineral density Blood glucose Eye exam (intraocular pressure, cataracts) Signs of adrenal suppression
Can you take corticosteroids during pregnancy and breast feeding
The benefit outweighs the risk
Women with fluid retention should be monitored closely
Treatment is required during labour
What are the main drug interactions corticosteroids have
- Metabolism accelerated by carbamazepine, phenobarbital, phenytoin, rifamycins
- Corticosteroids may induce or enhance anti-coagulant effect of coumarins
- High dose can impair immune response to vaccines; avoid use with live vaccines
- Mask GI effects of NSAIDS, avoid concomitant use and consider gastroprotection if possible
- HYPOKALEMIA when given with drugs that lower potassium levels (loop and thiazide diuretics)
- Anti-hypertensives and oral hypoglycaemic drugs are antagonised by glucocorticoids
