Side effects

Question 1

Corticosteroid patient counselling

Answer 1

1. Report any signs of infection
2. Report any behavioral changes / suicidal
3. Take with or just after food
4. Take with bisphosphonate to reduce OP risk
5. Risk of adrenal suppression - Don’t abruptly withdraw if >3 weeks, >40mg prednisolone daily or >1week, repeat doses taken in evening, recent repeated courses, other causes of adrenal suppression e.g. Addison’s disease, short course within 1 year of stopping long-term steroid

Question 2

Management of side effects

Answer 2

1. lowest effective dose for minimum time
2. local treatment rather than systemic
3. single dose in the morning - suppressive action on cortisol secretion is least in morning
   4, alternative day administration - take two days worth as single dose to further reduce adrenal suppression
4. Intermittently and short courses

Question 3

Side effects

Answer 3

“ACHING BOSOM”

1. Adrenal suppression - fatigue, anorexia, nausea, vomiting, hyponatremia, hypotension, hyperkaliemia, hypoglycemia. 1 year after stopping.
   * Avoid abrupt withdrawal if use >3 weeks = acute adrenal insufficiency, hypotension, death!
2. Cushing’s syndrome and cataracts
3. Hyperglycemia = diabetes
4. Infection - avoid close contact with chickenpox and shingles and measles
5. Nervous system - paranoia / depression and suicide risk whilst taking or on withdrawal. Mood and behavioral changes e.g. insomnia, euphoria, irritability, psychotic reactions. Aggravated epilepsy and schizophrenia
   * Report immediately
6. Glaucoma and GI irritation
   - MRHA warning: rare risk of central serous chorioretinopathy.
   * Report blurred vision/disturbances and refer to ophthalmologist
   - take with or just after food
7. Blood pressure increase
8. Osteoporosis - if use >3months, give bisphosphonate. High corticosteroid doses cause avascular necrosis of femoral head
9. Skin thinning, purple-red striae, bruising
10. Obesity
11. Muscle wasting - caution with stating and reduced growth in children