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Steroids
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> Info at start Why needed - to inc compliance How long for - may be years Addisonian crisis if stops suddenly Side effects Need for steroid card - if on for >3/52 Check for ... Other drugs Chicken Pox - immune status (if exposed and non-immune needs vaccine - ideally within 3/7 certainly within 10/7) Co-morbidities - osteopenia / osteoporosis, diabetes, peptic ulcer, glaucoma, HT, Immunosuppression Note Diabetes - may need to change dose of drugs (causes hypoglyc) Fracture - low fragility or FH - may need bisphosphonates Immunosuppression - weight up risks and benefits Hx peptic ulcer - if pain get in touch Drugs warfarin - enhances - so dec dose antiHT - antagonise - so ? inc Hypokalaemia - exacerbates drug induced NSAID - beware gastric SE SE Infections - if acute will need inc dose, vaccines - avoid (for 3/12) IF live Adrenal suppression Weight gain (inc appetite, and fat deposition) Psych effects (initially - including sleep) Hypertension - check annually Diabetes - inc blood glc - check annually Glaucoma and cataracts (esp open-angle G) - see urgently if Sx Osteoporosis - prophyllaxis - encourage weight bearing exercize (30mins/day), falls assessment, Not for DEXA routinely - use FRAX/Qfracture, Consider bisphosphonates with Vit D / Ca supplements if needed stop smoking, avoid xs alcohol Bisphosphonates If steroids >3/12 and >65 or <65 with Hx fragility fracture or Tscore<-1.5 (Do DEXA if <65 and repeat 1-3yrly) Calcium sardines (with bones), milk, bread, cheese Addisonian Crisis Nausea, vomiting, Dizzyness Mx - steroids, fluids, admit
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