Corticosteroids

Question 1

DOC for adrenal insufficiency?

Answer 1

Hydrocortisone or prednisolone

Question 2

With primary adrenal insufficiency with mineralocorticoid deficiency (addison’s) what do you add to hydrocort/prednisolone?

Answer 2

Fludrocortisone

Question 3

CS of choice for asthma/COPD exacerbations (oral)?

Answer 3

(adults) - prednisolone [prodrug]
(peds) - prednisone

Question 4

Maintenance ICS for Asthma/COPD?

Answer 4

inhaled; budesonide nebulizer

Question 5

For maintenance and/or acute relief for asthma?

Answer 5

Symbicort (Budesonide/formoterol)

Question 6

Autoimmune d/o like SLE or RA?

Answer 6

Prednisone

Question 7

Autoimmune d/o like IBD (2)?

Answer 7

Hydrocortisone (IV for severe)
Budesonide (rectal foam and capsules)

Question 8

Brain Tumors and chemotherapy or post-op INDUCED N/V?

Answer 8

Dexamethasone

Question 9

CS or acute URI or MSK injury?

Answer 9

Methylprednisolone dose pack (medrol Dosepak)

Question 10

Disseminated poison ivy/oak/sumac CS of choice?

Answer 10

Prednisone taper for 14-21 days
1 (0.5 for children)mg/kg/d or 30-60 mg/d

Question 11

Examples of inhaled CS?

Answer 11

Fluticasone, budesonide, Beclomethasone, Flunisolide, Ciclesonide, mometasone

Question 12

Examples of INCS?

Answer 12

Budesonide, fluticasone, mometasone

Question 13

Topical CS formulation examples?

Answer 13

Hydrocortisone 1% (low potent)
Mometasone 0.1% cream
Clobetasol 0.5% ointment (very high potent)

Question 14

Why are ointments more penetrable at lower doses compared to creams?

Answer 14

ointments are more lipophilic than creams

Question 15

CS depot formulations are why type of admin? for what?

Answer 15

Intra-articular for RA or gout

Question 16

Rectal CS formulation?

Answer 16

Budesonide

Question 17

The oral dose = IV dose for which three CS?
Why?

Answer 17

Methylprednisolone, hydrocortisone, and dexamethasone
Oral dose has 100% bioavailability

Question 18

What affect can oral steroids induce?

Answer 18

Hyperglycemia that can last up to 72 hours after d/c steroids

Question 19

What PO CS are there no hepatic or renal dose adjustments?

Answer 19

Prednisone, hydrocortisone, methylprednisolone, or dexamethasone

Question 20

CS drug interactions with floroquinolones?

Answer 20

tendon rupture risk

Question 21

CS drug interactions with NSAIDs?

Answer 21

GI upset

Question 22

CS drug interactions with warfarin?

Answer 22

increase or decrease INR

Question 23

Glucocorticoids; effecting the immune response?

Answer 23

hydrocortisone, Prednisone, prednisolone, methylprednisolone, Triamcinolone, Dexamethasone, Betamethasone

Question 24

Mineralocorticoids; effecting electrolytes?

Answer 24

Fludrocortisone

Question 25

Short term (1 mo) adverse effects of CS? (1-5)

Answer 25

1. increased appetite/weight gain 2. Emotional instability 3. HTN 4. Hyperglycemia 5. Insomnia (dose in AM)

Question 26

Short term (1 mo) adverse effects of CS? (6-10)

Answer 26

6. Indigestion - take with food 7. Increased intraocular pressure 8. Inhaled - Thrush 9. INCS - epistaxis 10. Topical - skin thinning

Question 27

Long term CS adverse effects

Answer 27

infection susceptibility Redistribution of fat Suppression of osteoblast function Avascular necrosis of bone (women) - menstrual irregularities, hirsutism