Steroids

Question 1

Indication for systemic steroids

Answer 1

1. Autoimmune disorders (SLE, RA, polymyalgia rheumatica, Crohn’s)
2. Asthma/COPD/Pneumonia
3. Anaphylaxis
4. Cancer
5. Transplant Medicine
6. Steroid deficient states (Addison’s, adrenal insufficiency)
7. Maturation of fetal lungs

Question 2

Contraindications for systemic steroids

Answer 2

active serious infection (viral, fungal)

caution with diabetics b/c can cause hyperglycemia

Question 3

systemic steroids MOA

Answer 3

suppresses immune reactions/inflammatory response

Question 4

Examples of systemic steroids

Answer 4

1. Prednisone
2. Methylprednisolone (medrol)
3. Dexamethasone

Question 5

Patient Education for systemic steroids

Answer 5

1. requires gradual taper to prevent adrenal suppression

2. important to take medication as directed

Question 6

systemic steroids side effects

Answer 6

1. hyperglycemia
2. weight gain and swelling
3. psychiatric (depression, mania, psychosis, euphoria, insomnia, mental confusion)
4. GI bleeding
5. HTN
6. Infections, delayed wound healing
7. thin skin, stretch marks, acne, facial flushing
8. cataracts, glaucoma
9. muscular wasting, pain
10. adipose distribution (buffalo hump, central obesity)
11. osteoporosis, avascular necrosis
12. cushing syndrome
13. suppression of growth (short stature)
14. adrenal suppression

Question 7

What do you need to monitor when giving systemic steroids and why?

Answer 7

1. WBC

2. can cause increase in WBC so makes it difficult to determine whether high WBC is from infection of steroids

Question 8

Drug Interactions of systemic steroids

Answer 8

NSAIDs –> higher GI bleed risk

Question 9

Signs of Cushing’s syndrome

Answer 9

1. moon facies
2. central obesity
3. buffalo hump
4. supraclavicular fat collection

Question 10

what labs must you monitor with giving long-term steroids?

Answer 10

WBC because steroids can increase WBC count

Do CBC!!

Question 11

Effects of steroids on labs

Answer 11

Increases
1. serum glucose
2. muscle breakdown
3. neutrophil count (immature)
4. Ca mobilization from bone
Decreases 
1. WBC
2. cell division
3. phospholipase A2