Steroids
Mechanism of Action
Potential Side Effects of Steroids
Indications (Not an exhaustive list)
Take Home
Steroids are a commonly used group of medications in the Emergency Departments. There are plenty of indications to use them, some remain controversial while others are widely accepted. Most side effects result from long-term usage but its worth having a discussion with the patient when prescribing steroids to take away.
Mechanism of Action
- Steroids work by reducing the production of leukotrienes and prostaglandins
- Inhibits phospholipase A2 and expression of COX-2
- Stimulate the bone marrow to produce neutrophils resulting in leukocytosis\
- Halting inflammatory cascade
https://step1.medbullets.com/endocrine/109043/glucocorticoids |
Potential Side Effects of Steroids
- Impair immunity
- Hyperglycemia
- Hypertension
- GI Ulcers
- Delay Wound Healing
- Increase Risk for Cardiovascular diseases
- Weight gain
- Osteoporosis
- Myopathy
- Avascular Necrosis
- Depression/Mood changes
Tapering is not generally needed for short courses (up to 2 weeks)
Indications (Not an exhaustive list)
- Intracranial SOL
- Strep Pnemo Meningitis
- Pharyngitis (steroids did decrease the duration of symptoms by about 24-48 hours.)
- Asthma/COPD
- Allergic Reactions
- Connective Tissue Flare
- Bells Palsy
- Gout
- ?Headache (Steroids prevent recurrence)
- Septic Shock
- Temporal Arteritis
- Addisons Crisis (Hypoadrenal Shock)
- ?Pnemonia
- ?Back Pain in selected patients
Take Home
- Discuss pros and cons of prescribing steroids
- Short courses from ED do not require tapering
Posted by:
Lakshay Chanana
ST4 Trainee
Royal Infirmary of Edinburgh
Department of Emergency Medicine
Edinburgh
Scotland