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Therapeutics 2 - Fall 2017 > Chen's Corticosteroid Lecture > Flashcards

Chen's Corticosteroid Lecture Flashcards

1
Q

What are the equivalent doses?

Hydrocortisone _____ = Cortisone _____ = Prednisone ______ = Methylprednisolone _____ = Dexamethasone ______

A

20 mg; 25 mg; 5 mg; 4 mg; 0.75 mg

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2
Q

which glucocorticoid drug is most like the body’s natural steroid produced

A

hydrocortisone

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3
Q

which steroid has the most mineralcorticoid action

A

fludrocortisone

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4
Q

For the steroid drugs: if there is more potent GC activity - there is a (shorter or longer) duration of action

A

LONGER!

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5
Q

For Steroid Drugs there are two kinds of dosing: _________ or _________

A

Physiologic; Pharmacologic

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6
Q

The physiologic dose of hydrocortisone is: ______/day

A

20 mg

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7
Q

The physiologic dose of prednisone is: __________/day

A

5 - 7.5 mg

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8
Q

The physiologic dose of dexamethasone is: ______________/day

A

0.75 mg

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9
Q

The physiologic dose of methylprednisolone is: ____________ /day

A

4 mg

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10
Q

A pharmacologic dose of prednisone is anything greater than ________

A

physiologic dose

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11
Q

Why should steroids be dosed in the morning (before 9 AM)?

A
  • mimics natural circadian rhythm

- pituitary is less sensitive to steroid during this time

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12
Q

Intra-articular dosing of steroids: has (slow or fast) absorption and (short or long) duration of action

A

fast; long

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13
Q

Longer or shorter acting steroids improve adherence?

A

Longer (duh, bc won’t have to take the steroid as often!)

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14
Q

Using steroids for Anti-inflammatory means:

  • use a steroid with (min or max) effect of mineralcorticoids
  • want length of action of steroid is best? (short, intermediate, long)
A

MIN!; intermediate (therefore not too much dosing and too long not needed…)

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15
Q

List possible complications of Corticosteroid Therapy

A

infections; myopathy; osteoneocrosis; osteoporosis; psychiatric sx; Fluid and salt retention; metabolic changes; gastric ulcer; cataract; CV Risk

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16
Q

How to manage an infection due to Corticosteroid Therapy:

A

treat infection; rinse mouth after inhaled steroid

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17
Q

what are the psychiatric symptoms of corticosteroid therapy

A
  • nervousness/anxiety
  • insomnia
  • mood swings/depression/personality changes
  • poor concentration/ memory
  • overy psychosis/hallucination
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18
Q

How to manage fluid and salt retention that can come from Corticosteroid Therapy

A
  • treat edema & HTN
  • reduce Na+ intake
  • Supplement with K+ if needed
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19
Q

How to manage metabolic changes that come from Corticosteroid Therapy

A

diet; hypoglycemia agents; insulin

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20
Q

what are things to monitor for gastric ulcer complications from Corticosteroid Therapy

A
  • burning pain/heartburn
  • black/dark stools
  • vomiting blood
  • weight loss
  • bloating
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21
Q

how to manage a gastric ulcer complication that results from Corticosteroid Therapy

A
  • prevent (prophylaxis) w/ PPI or H2 receptor antagonists

- AVOID large doses of antacids

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22
Q

What things must be monitored while a pt is on Corticosteroid Therapy - related to CV risk

A
  • BP
  • Cholesterol
  • HR
  • Edema
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23
Q

how to manage osteoporosis when resulting from Corticosteroid Therapy

A
  • supplement Ca2+ and vit. D
  • weight bearing exercises
  • avoid smoking
  • treat w/ bisphosphonates
24
Q

Cushings syndrome occurs because there is (too much or too little) cortisol in the body

A

too MUCH

25
Q

T or F: Not all forms of steroid with glucocorticoid activity can cause Cushings

A

FALSE - all forms w/ GC activity can cause Cushings

26
Q

What are some non corticosteroids that have glucocorticoid activity - aka should be warned about Cushings

A
  • Megestrol (Megace)

- Depo-Provera

27
Q

Treatment Goals of Cushings Syndrome

A
  • Reverse hypercortisolism
  • reduce exogenous glucocorticoid administration
  • Manage co-associated co-morbidities (large increase in mortality in CV disease)
  • minimize long term complications
28
Q

When to start Glucocorticoid Withdrawal?

A
  • max desired therapeutic benefit has been attained
  • inadequate therapeutic benefit has been obtained
  • side effects are too serious/uncontrollable (HTN, osteoporosis, Cushing’s Syndrome)
29
Q

NEVER STOP A CORTICOSTEROID IMMEDIATELY - Especially if pt was getting dose > __________ for long term (aka > _________)

A

7.5 mg/day; 3 weeks

30
Q

When tapering off of corticosteroids: How to PREVENT adrenal Crisis:

  • asses the pts risk for adrenal insufficiency
  • gradually taper dose til at about prednisone _____ mg daily - give in AM
  • then move to dosing of EVERY OTHER day
A

20;

31
Q 
Steroid Tapering: Can stop steroid when it reaches a \_\_\_\_\_\_\_\_ dose:
which would be 
Hydrocortisone \_\_\_\_\_\_
Prednisone \_\_\_\_\_\_\_\_
Dexamethasone \_\_\_\_\_\_\_
A

physiologic; 20 mg/day; 5 - 7.5 mg/day; 0.75 mg/day

32
Q

What kinds of drugs should be avoided to help prevent the development of hypocortisolism

A

(want to avoid CYP3A4 INDUCERS - bc inducers will increase the metabolism of cortisol and lead to hypocortisolism)
CYP3a4 inducers are: phenytoin, rifampin, barbiturates, carbamazepine

33
Q

what drugs are CYP3a4 inducers

A

phenytoin, rifampin, barbiturates, carbamazepine

34
Q

if a CYP3a4 inducer is present whilst using glucocorticoids - should you decrease or increase the dose of glucocorticoids

A

INCREASE dose

35
Q

Ways to prevent hypercortisolism -

- give ________ GC dose and for the ______ amount of time

A

lowest;shortest

36
Q

Ways to prevent hypercortisolism -

- give GC dose via administration routes that (decrease or increase) systemic absorption and what are examples of that

A

DECREASE; inhalation and topical

37
Q

Ways to prevent hypercortisolism -

Give GC treatment (every day/ every other day/ twice a day)

A

every OTHER day

38
Q

Ways to prevent hypercortisolism -

avoid GC doses with CYP3a4 (inducers or inhibitors)

A

inhibitors! CYP3a4 inhibitors will lead to too much GC in the body since the inhibitors are preventing the metabolism of GC

39
Q

Examples of CYP3a4 inhibitors

A

protease inhibitors (drugs that end in -avir), antifungals

40
Q

if a CYP3a4 inhibitor is being used while on GC dose - how should you change the GC dose to prevent possible drug interactions

A

DECREASE the dose - to prevent hypercortisolism

41
Q

Counseling Points for GC Therapy:

let pt be aware of potential side effects: like ______ disturbances, ______ and _____ wound healing

A

visual; brusiing; delayed

42
Q

primary adrenal insufficiency occurs at the ______ in the body

A

adrenal gland

43
Q

what are causes of primary adrenal insufficiency

A

Main reason is Addison’s Disease; drugs and some infections can cause this too

44
Q

what is the common cause for secondary adrenal insufficiency

A

EXOGENOUS steroid level/dose is too high

45
Q

what is the common cause for tertiary adrenal insufficiency

A

EXOGENOUS steroid level/dose is too high

46
Q

Primary/Secondary/Tertiary Adrenal Insufficiency - which one(s) need MINERALCORTICOID supplementation

A

ONLY primary - because adrenal gland will make MC; 2 and 3 don’t affect MC making….

47
Q

Primary/Secondary/Tertiary Adrenal Insufficiency - which one(s) need lifelong supplementation

A

PRIMARY ONLY - 2 and 3 are usually due to too high of dose - just adjust dose until HPA adjusts

48
Q

Cushings or Addisons Disease? “Pt looks great (aka Tan) but feels awful”

A

Addisons! (Pt pigmentation and weakness is addisions disease)

49
Q

Weakness and Fatigue ar signs of Cushings or Addisons?

A

Addisons! (Remember cortisol is used in morning to help get you around…. lack of cortisol = tiredness - addisons has lack of cortisol….)

50
Q

Treatment Goals of Adrenal Insufficiency:

  • to mimic endogenous secretion of GC via ________
  • replace both _________ and _______ deficiencies
  • manage symptoms of adrenal insufficiency and prevent adrenal crisis
A

GC replacement therapy; GC; MC

51
Q

Typical Dosing Regimen for Short Acting Steroid - using for Chronic Adrenal Insufficiency

A

Give 2/3 of dose in AM ( 6 - 8 am)

Give 1/3 of dose in early afternoon (2 - 4 pm)

52
Q

Traditional Replacement for Adults with Chronic Adrenal Insufficiency
____________ at ____ mg/day
or
___________ at ____ mg/day

A

Hydrocortisone; 15 - 25; Cortisone; 20 - 35

53
Q

If adrenal insufficient pt is going under stressful situation (infection/ surgery/fever) - what should happen to their GC dose?

A

INCREASE IT! body needs more steroid to compensate for the stress on the body

54
Q

Adrenal insufficient patients should wear ________

A

a medical alert bracelet/ necklace

55
Q

5 S’s of adrenal crisis management

A

steroids; salt; sugar; support; search
(support is fluid/hydration)
(search is for underlying cause)

56
Q

What are signs of over replacement of steroids/HYPERcortisolism

A
  • weight gain
  • stretch marks
  • impaired glucose tolerance
  • High BP
  • Central/trunkal obesity

Therapeutics 2 - Fall 2017 (22 decks)

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