Corticosteroids

Question 1

what are the CI of steroids?

Answer 1

• avoid injections containing benzyl alcohol
• avoid live vaccines
• systemic infections

Question 2

what are the cautions of steroids?

Answer 2

• congestive HF
• diabetes (including family History)
• diverticulitis
• epilepsy
• glaucoma
• history of steroid myopathy
• hypothyroidism
• intreated infection
• psychriatric reactions
• recent MI
• Peptic ulcer

Question 3

explain the further info on the SE of adrenal supression:

Answer 3

• during prolonged systemic therapy, adrenal atrophy develops and can persist for years after stopping.
• abrupt withdrawal after prolonged therapy can lead to acute adrenal insufficiency, hypotension and sudden death.

Question 4

explain the further info on the SE of infections:

Answer 4

prolonged courses of steroids increases the suspectibility to infections and severity.

Question 5

explain the further info on the SE of chickenpox and measles:

Answer 5

unless pt has had chickenpox before, pts are at high risk of severe chickenpox.

immunisation of varicella- zoster vaccine is needed in non- immune pts.

confirmed chickenpox: immediate care needed. do not stop steroids and dose may need to be increased.

measles: avoid exposure to measles.

Question 6

explain the further info on the SE of psychiatric reactions

Answer 6

• steroids, especially at high doses is linked to psychiatric reactions:
• (euphoria, insomnia, irritability, mood liability, suicidal thoughts, behavioural issues)
• usually subside on reducing the dose or stopping therapy.
• SEEK MEDICAL ATTENTION especially if depression, suicidal thoughts

Question 7

gradual withdrawal of steroids should be considered in those who disease is unlikely to relapse and have….?

Answer 7

• received more than 40mg prednisolone (or eqiv) OD for more than a week.
• been given repeated doses in the evening
• received more than 3 weeks treatment
• recently received repeated courses (especially taken for longer than 3 weeks)
• taken a short course within 1 year of stopping long term therapy

Question 8

what is the MHRA/CHM advice for steroids?

Answer 8

• rare risk of central choriretinopathy

- report any blurred vision or other visual disturbances