Corticosteroids : Uses and Cautions
Related Subjects:
|Beta Antagonists/Blockers
|Calcium Channel Blockers
|Corticosteroids
⚙️ Mode of Action
- 💊 Steroids (corticosteroids) are synthetic forms of cortisol from the adrenal glands.
- 🔗 Bind glucocorticoid receptors → alter gene transcription → anti-inflammatory & immunosuppressive effects.
- 🔥 Reduce cytokines & immune cell activation → suppress inflammation.
📌 Indications
- 🦠 Autoimmune: RA, lupus, MS.
- 🤧 Allergic: Anaphylaxis, angioedema, severe allergy flares.
- 🫁 Respiratory: Asthma, COPD exacerbations.
- 🩺 Endocrine: Adrenal insufficiency (Addison’s disease).
- 🎗 Oncology: Cerebral oedema, chemo-induced nausea, appetite stimulation.
📖 Drug Classes
- 🧪 Glucocorticoids: Prednisone, prednisolone, dexamethasone, methylprednisolone.
- 💧 Mineralocorticoids: Fludrocortisone (fluid/electrolyte balance, adrenal replacement).
💉 Delivery Forms
- 💊 Oral: Prednisone, prednisolone (chronic use).
- 💉 IV: Methylprednisolone, dexamethasone (acute severe illness).
- 🌬️ Inhaled: Beclometasone, budesonide (asthma, COPD).
- 🧴 Topical: Hydrocortisone, betamethasone (eczema, psoriasis).
- 💉 IM: Longer-acting (e.g. allergy flare, depot injection).
⚠️ Side Effects (high-yield)
- 🦴 Osteoporosis (long-term use).
- 🍬 Hyperglycaemia → diabetes risk.
- ⚖️ Weight gain & fluid retention.
- 🦠 Infection risk due to immunosuppression.
- 🌙 Cushingoid features: “moon face”, “buffalo hump”.
- 🧠 Psychiatric: insomnia, mood swings, psychosis.
💊 Drug Interactions
- 💊 + NSAIDs → ↑ GI bleed/ulcer risk.
- 💊 + Diuretics → worsens hypokalaemia.
- 💊 + Diabetes meds → reduces effect, ↑ glucose.
- 💊 + Warfarin → enhances anticoagulant effect (↑ INR).
🩺 Monitoring & Precautions
- 📈 Monitor BP, blood glucose, U&Es.
- 🦴 Check bone density (risk of osteoporosis).
- 🦠 Look for infection signs.
- ⏳ Never stop abruptly → taper to avoid adrenal crisis.
👩⚕️ Patient Education
- ⏬ Taper slowly, don’t stop suddenly.
- 🧠 Report mood changes, weight gain, excessive thirst/urination.
- 🥛 Maintain calcium + vitamin D; consider osteoporosis prevention.
- 💳 Carry a “steroid card” for emergencies.
📋 Common Steroids & Uses
- 💊 Prednisone/Prednisolone: 5–60 mg OD → autoimmune, asthma, IBD.
- 💊 Dexamethasone: 0.5–4 mg OD → cerebral oedema, cancer, severe inflammation.
- 💊 Methylprednisolone: 4–48 mg OD → autoimmune flares, severe asthma.
- 💊 Hydrocortisone: 20–240 mg/day → adrenal insufficiency, shock.
- 🌬️ Beclometasone (inhaled): 100–400 mcg BD → asthma, COPD.
- 🌬️ Budesonide (inhaled): 200–800 mcg BD → asthma, COPD.
- 💧 Fludrocortisone: 0.1 mg OD → adrenal insufficiency, POTS, hypotension.
🚨 Cautions
- 🧪 TB, sepsis, untreated infection, immunocompromised.
- 🤰 Pregnancy (use with caution).
- 🍬 Diabetes, PUD, renal/hepatic dysfunction.
- ⚡ Malignant hypertension, sarcoidosis.
⚖️ Equivalent Anti-Inflammatory Doses
- Prednisolone 5 mg ≈ Hydrocortisone 20 mg ≈ Methylprednisolone 4 mg ≈ Dexamethasone 0.75 mg ≈ Betamethasone 0.75 mg.
📝 Prescribing Advice
- 🎯 Use local (cream, eye drops) where possible instead of systemic.
- ⬇️ Always aim for the lowest effective dose.
- 💳 Provide patient with a “steroid card”.
- 🐔 Warn about chickenpox/shingles exposure risk → may need urgent prophylaxis (VZIG).
🦠 Infection Risk Precautions
- 👥 Avoid close contact with chickenpox or shingles.
- 💉 Varicella-zoster immunoglobulin within 3–10 days if exposed (non-immune + on systemic steroids).
- 💉 Normal immunoglobulin may be given for measles exposure in immunocompromised patients.
