Since everyone is suddenly VERY INTERESTED in steroid side effects https://abs.twimg.com/emoji/v2/... draggable="false" alt="🙃" title="Auf den Kopf gestelltes Gesicht" aria-label="Emoji: Auf den Kopf gestelltes Gesicht">, here is a https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread"> of the ones that your preceptors would likely expect you to be aware of as a #pharmacystudent.

1/11

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧠" title="Gehirn" aria-label="Emoji: Gehirn"> + https://abs.twimg.com/emoji/v2/... draggable="false" alt="💤" title="Schlafsymbol" aria-label="Emoji: Schlafsymbol">: Mood and sleep disturbances. Sometimes psychosis, which is getting all the attention rn, but minor changes - like irritability - are more common.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="♥️" title="Herz" aria-label="Emoji: Herz">: Hypertension as a long-term side effect. Hypotension as a short-term side effect during / immediately after an IV dose.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦠" title="Microbe" aria-label="Emoji: Microbe">: Immunosuppression / increased risk of infection / altered response to vaccines.

It’s a topic worthy of a https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread"> of its own, but https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔑" title="Schlüssel" aria-label="Emoji: Schlüssel"> for #pharmacystudents on a #PedsPharm rotation is to double-check https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Fettes Häkchen" aria-label="Emoji: Fettes Häkchen"> CDC guidance on vaccine schedules https://abs.twimg.com/emoji/v2/... draggable="false" alt="💉" title="Spritze" aria-label="Emoji: Spritze"> https://abs.twimg.com/emoji/v2/... draggable="false" alt="📆" title="Abreißkalender" aria-label="Emoji: Abreißkalender"> and steroids.

3/11

https://abs.twimg.com/emoji/v2/... draggable="false" alt="❗️" title="Rotes Ausrufezeichen" aria-label="Emoji: Rotes Ausrufezeichen">: Hypothalamic-pituitary-adrenal (HPA) suppression.

Another topic worthy of its own https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">, but https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔑" title="Schlüssel" aria-label="Emoji: Schlüssel"> for #pharmacystudents is to remember steroid tapers are as much art https://abs.twimg.com/emoji/v2/... draggable="false" alt="🎨" title="Farbpalette" aria-label="Emoji: Farbpalette"> as science https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧪" title="Test tube" aria-label="Emoji: Test tube">, so go ahead and calculate https://abs.twimg.com/emoji/v2/... draggable="false" alt="➗" title="Dickes Divisionszeichen" aria-label="Emoji: Dickes Divisionszeichen">https://abs.twimg.com/emoji/v2/... draggable="false" alt="✖️" title="Fettes Malzeichen x" aria-label="Emoji: Fettes Malzeichen x"> the “ideal” regimen, but then ROUND IT to something measurable.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💪🏽" title="Angespannter Bizeps (mittlerer Hautton)" aria-label="Emoji: Angespannter Bizeps (mittlerer Hautton)">: Myopathy.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦴" title="Bone" aria-label="Emoji: Bone">: Osteopenia / osteoporosis as a long-term side effect.

In the peds lupus clinic, bone health is the most common topic Grace and I review with patients! We talk about weight-bearing exercise https://abs.twimg.com/emoji/v2/... draggable="false" alt="🏋🏾‍♀️" title="Woman lifting weights (durchschnittlich dunkler Hautton)" aria-label="Emoji: Woman lifting weights (durchschnittlich dunkler Hautton)">, calcium-rich foods / calcium supplements https://abs.twimg.com/emoji/v2/... draggable="false" alt="🥛" title="Glas Milch" aria-label="Emoji: Glas Milch">, and vitamin D https://abs.twimg.com/emoji/v2/... draggable="false" alt="☀️" title="Sonne mit Strahlen" aria-label="Emoji: Sonne mit Strahlen">.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👁" title="Auge" aria-label="Emoji: Auge">: Blurred vision, cataracts, glaucoma.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🍭" title="Lolli" aria-label="Emoji: Lolli">: Impaired glucose metabolism, insulin resistance, beta cell dysfunction.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💧" title="Tröpfchen" aria-label="Emoji: Tröpfchen">: Fluid retention, edema.

6/11

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤢" title="Angewidertes Gesicht" aria-label="Emoji: Angewidertes Gesicht">: GI upset, or worse, gastric ulcers. Concomitant NSAIDs may increase the risk, and H2 antagonists are sometimes added as a protective measure. ( #TwitteRx could probably have a very long, heated debate about this topic... )

7/11

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧴" title="Lotion bottle" aria-label="Emoji: Lotion bottle">: I’m intentionally not talking about topical steroids in detail, because there is already a great https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread"> out there, but!!!

An ADE + counseling point that I often see #pharmacystudents forget: Steroids cause thinning of the skin. Apply as a THIN layer. https://twitter.com/drsteventchen/status/1123605778127052800?s=21">https://twitter.com/drstevent...

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚪️" title="Weißer Kreis" aria-label="Emoji: Weißer Kreis"> Leukocytosis. There’s an interesting https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread"> here: https://twitter.com/tony_breu/status/1053671032140251136?s=21">https://twitter.com/tony_breu...

And if you’re a #pharmacyresident on a #specialtypharmacy learning experience, you might want to know more about steroids and eosinophils specifically. There’s an amazing https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread"> here: https://twitter.com/avrahamcoopermd/status/1304825763984703489?s=21">https://twitter.com/avrahamco...

#TwitteRx please chime in https://abs.twimg.com/emoji/v2/... draggable="false" alt="🛎" title="Empfangsglocke" aria-label="Emoji: Empfangsglocke"> if I missed something super interesting or specific to a certain patient population!

And quick study tips:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🖍" title="Buntstift unten links" aria-label="Emoji: Buntstift unten links"> Draw a stick figure and write in ADEs over corresponding body parts / organ systems.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦶🏻" title="Foot (heller Hautton)" aria-label="Emoji: Foot (heller Hautton)">Listing them head to toe used to help me!

11/11