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DR Medhat MRCP

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Corticosteroids :<br />

- The relative glucocorticoid and mineralocorticoid activity of steroids :<br />

Minimal<br />

glucocorticoid<br />

activity, very high<br />

mineralocorticoid<br />

activity,<br />

Glucocorticoid<br />

activity, high<br />

mineralocorticoid<br />

activity,<br />

Predominant<br />

glucocorticoid<br />

activity, low<br />

mineralocorticoid<br />

activity<br />

Very high<br />

glucocorticoid<br />

activity, minimal<br />

mineralocorticoid<br />

activity<br />

Fludrocortisone Hydrocortisone Prednisolone Dexamethasone<br />

Betmethasone<br />

• Side-effects :<br />

Endocrine: impaired glucose regulation, increased appetite/weight gain, hirsutism,<br />

hyperlipidaemia<br />

Cushing's syndrome: moon face, buffalo hump, striae<br />

Musculoskeletal: osteoporosis, proximal myopathy, avascular necrosis of hip hoints<br />

Immunosuppression: increased susceptibility to severe infection, reactivation of TB<br />

Psychiatric: insomnia, mania, depression,Psychosis.<br />

Gastrointestinal: peptic ulceration, acute pancreatitis<br />

Ophthalmic : glaucoma, cataracts<br />

Suppression of growth in children<br />

Intracranial hypertension<br />

Mineralocorticoid side-effects<br />

1) Fluid retention<br />

2) Hypertension<br />

• Selected points on the use of corticosteroids:<br />

o Patients on long-term steroids should have their doses doubled during<br />

سؤال هام intercurrent illness e.g pneumonia<br />

o The BNF suggests gradual withdrawal of systemic corticosteroids if patients<br />

have<br />

a) Received more than 40mg prednisolone daily for more than one week<br />

b) Received more than 3 weeks treatment or recently received repeated<br />

courses<br />

اللهم اجعل هذا العمل خالصا لوجهك الكريم وعلما ينتفع به بعد مماتي ..<br />

أن أشرك بك شيئا أعلمه وأستغفرك لما ال أعلمه<br />

اللهم اني أعوذ بك

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