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Steroid sick day advice — GPhC CRA MCQ

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ModerateEndocrine TherapeuticsSteroid sick day adviceGPhC CRA

A 43-year-old man takes prednisolone 20 mg daily for polymyalgia rheumatica and collects an early repeat before a two-week holiday. He asks what to do if he develops vomiting and cannot keep tablets down. What would you advise the patient?

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Correct answer: D — Seek urgent medical advice because missed systemic corticosteroids can cause adrenal crisis

Longer courses of systemic corticosteroids can suppress the hypothalamic-pituitary-adrenal axis. Vomiting may prevent absorption and create risk of adrenal insufficiency, particularly if the patient cannot keep doses down. The patient should seek urgent medical advice and carry steroid information where appropriate. Topical hydrocortisone or NSAIDs are not substitutes for systemic steroid cover.

Reference: BNF; NICE CKS