Corticosteroids (tablets)

Question 1

What are the generic and brand names of corticosteroid tablets?

Answer 1

• Prednisolone (Pred Forte)
• Dexamethasone
• Betamethasone
• Hydrocortisone
• Budesonide

Question 2

What is the method of action of tablet corticosteroids?

Answer 2

• Bind to cytosolic glucocorticoid receptors
• Translocation to the nucleus and binding to glucocorticoid response elements = regulate gene expression
• Upregulate anti-inflammatory genes and downregulate pro-inflammatory genes
• Supresses circulating monocytes/eosinophils
• ↑ gluconeogenesis from amino acids and fatty acids
• Mineralocorticoid effect = stimulate Na+ and water retention and K+ excretion in the renal tubules

Question 3

What are the indications for tablet corticosteroids?

Answer 3

• To treat allergic/inflammatory disorders e.g.
• asthma
• Suppression of autoimmune diseases e.g. IBD
• Treatment of cancers as part of chemotherapy/reduce tumour associated swelling
• Hormone replacement in adrenal insufficiency/hypopituitarism

Question 4

What are the contraindications for corticosteroid tablets?

Answer 4

• Already have an infection

* Children – supresses growth

Question 5

What are the side effects of corticosteroid tablets?

Answer 5

• ↑ risk and severity of acquiring infections
• Diabetes
• Osteoporosis
• Proximal muscle weakness
• Skin thinning
• Easy bruising
• Gastritis
• Insomnia
• Confusion
• Psychosis
• Suicidal ideas
• Hypertension
• Hypokalaemia
• Oedema
• Adrenal atrophy = Addisonian crisis with CV collapse

Question 6

What are the interactions with corticosteroid tablets?

Answer 6

• NSAIDs - ↑ risk of peptic ulcers/GI bleeding
• Beta 2 agonists - ↑ hypokalaemia
• Theophylline - ↑ hypokalaemia
• Loop diuretic - ↑ hypokalaemia
• Thiazide diuretic - ↑ hypokalaemia
• Vaccines – steroids reduce immune response
• Cytochrome P450 inducers e.g. phenytoin, carbamazepine – efficacy ↓

Question 7

What organ eliminates corticosteroid tablets?

Answer 7

Liver

Question 8

What information should the patient be told before taking corticosteroid tablets?

Answer 8

• Should start to feel a difference in 1-2 days

* Do not stop the medication suddenly