Saturday, 20 December 2014

Super Duper List of Steroid side effects

Steroids are some of the most commonly prescribed drugs in health care settings. They include:
  • Inhaled corticosteroids for asthma and COPD
  • Intranasal corticosteroids for allergic rhinitis
  • Oral steroids for autoimmune conditions and acute asthma/COPD
  • Intravenous steroids for multiple sclerosis
and so forth.
As they are so commonly prescribed, it is important to have a good understanding of the side effect profile of these medications. Also, this is a commonly asked question to students on the wards/clinic, and in clinical exams. 

My approach to remembering the side effects is a "head to toe" system, taking each organ/system as it comes, and finishing with the systemic effects. This is just one of no doubt many ways to learn them!

Also, it is important to split the side effects into short term and long term. This is because many patients only use a short course of steroids, during or following a hospital admission. With a week's use or less, the long term effects are not so relevant. However, in patient's with longstanding or terminal conditions, long term use of steroids may be an inevitability. In these patients, the long term side effects are the more important.

Important to note that these side effects generally only relate to systemic use of steroids (primarily oral, intravenous), rather than the local use of steroids (eg. asthma puffers, topical eczema treatment). Local steroid use confers a lower side effect risk generally.

So without further ado:

Short term

  • Psychiatric disorders – mania, psychosis, depression, anxiety
  • Insomnia

Neck and chest
  • Heart failure (secondary to water retention)

  • Peptic ulceration
  • Increased appetite
  • Weight gain

Lower limbs
  • Muscle weakness
  • Avascular necrosis of the hip

  • Leukocytosis
  • Water retention
  • Impaired glucose tolerance

Long term

  • Insomnia
  • Glaucoma
  • Cataracts (posterior subscapular)
  • Psychiatric – mania, bipolar, depression, psychosis, delirium, memory loss
  • Oral candidiasis
  • Stroke (from atherosclerosis)

Neck and chest
  • Atherosclerosis – IHD, stroke
  • Heart failure (secondary to fluid retention)

Upper limbs
  • Muscle wasting / myopathy
  • Delayed wound healing
  • Increased blood pressure

  • Osteoporosis
  • Vertebral fractures

  • Peptic ulceration, gastritis (be wary with those taking NSAIDs)
  • Adrenal suppression (upon sudden withdrawal)
  • Impaired glucose tolerance
  • Cushing’s syndrome (also see under Systemic)
  • Hepatic steatosis

  • Irregular menstruation
  • Reduced fertility

Lower limbs
  • Muscle wasting / myopathy
  • Leg swelling
  • Avascular necrosis of hip and long bones
  • Delayed wound healing

  • Increased susceptibility to skin infections
  • Skin thinning, more bruising and tearing
  • Striae
  • Hair gain (hypertrichosis) or Hair loss (alopecia)

  • Immunosuppression
  • Masking symptoms of infection
  • Water retention
  • Cushing’s syndrome – moon facies, buffalo hump, central obesity, sweating, thin skin, striae, hirsutism, acne, mood changes etc.

Also you could try learn the CUSHINGOID mnemonic.

Enjoy! Hope it is useful!

Sourced from:

  • The H Book: the UWA bible of med student notes and summaries
  • DermNet NZ
  • Dynamed

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