Steroids

Question 1

steroids S/E?

CUSHINGOID mnemonic

Answer 1

Cataracts
Ulcers
Striae and skin thinning
Hypertension and hirsutism
Immunosuppression and infection
Necrosis of femoral head
Glucose elevation
Osteoporosis and obesity
Impaired wound healing
Depression and mood changes

Question 2

what to prescribe alongside long term steroids?

Answer 2

give PPI and BISPHOSPHONATE

Question 3

Sx of severely hydrocortisone depleted Addisons patient? (ie, very unwell and on normal steroid dose)

Answer 3

postural drop in BP

always increase steroids if unwell

Question 4

how do steroids cause stomach ulcers?

Answer 4

inhibit gastric tissue renewal

Question 5

steroids and HF?

Answer 5

avoid!

Question 6

effect of steroids on wbc?

Answer 6

↑ (non-infective)

Question 7

Steroid S/E?

“STEROIDS” mnemonic

Answer 7

Stomach ulcers
Thin skin
oEdema
Right and L HF
OP
Infection (candida)
DM (↑ glucose)
Cushings Syndrome

Question 8

long term steroid sick day rules?

Answer 8

double the dose

Question 9

5mg pred is = to how much hydrocortisone?

Answer 9

20mg hydrocortisone

Question 10

Tx flare of RA?

long term Tx RA?

Answer 10

IM methylprednisolone 80 mg
ibuprofen + PPI

• methotrexate + DMARD (sulfasalazine or hydroxychloroquine)
• failure to respond to two DMARDs, TNF-α inhibitors, e.g. infliximab

Question 11

when to give dose of prednisolone?

Answer 11

morning after breakfast (bc cortisol peaks here)

Question 12

how to give hydroocortisone for adrenal replacement?

Answer 12

diurnal mimic - larger dose in the morning and smaller in the evening

Question 13

when to consider gradual withdrawal of systemic corticosteroids?

Answer 13

• > 40 mg prednisolone (or equivalent) daily for > 1 week;
• been given repeat doses in the evening;
• received > 3 weeks’ treatment;
• recently received repeated courses (particularly if taken for longer than 3 weeks);
• taken a short course within 1 year of stopping long-term therapy;
• other possible causes of adrenal suppression.

Question 14

Systemic corticosteroids may be stopped abruptly in those whose…?

Answer 14

disease is unlikely to relapse

and have received treatment for 3 weeks or less