28 - 184 - GLUCOCORTICOIDS Flashcards
Ear pits are located in the preauricular area near the ascending limb of
Percutaneous absorption process occurring in the epidermis, except
a. Diffusion
b. Metabolism
c. Binding
d. Reservoir function
D
Which is NOT an intermediate-acting systemic glucocorticoid?
a. cortisone
b. prednisone
c. methylprednisolone
d. prednisolone
A
Short-acting
Cortisone
Cortisol
Intermediate acting:
Prednisone
Prednisolone
Triamcinolone
Methylprednisolone
Long-acting
Dexamethasone
Betamethasone
Any patient on glucocorticoid therapy for 3 months or longer should receive?
a. Calcium 1000mg/day; Vitamin D 800 IU/day
b. Calcium 1200mg/day; Vitamin D 600 IU/day
c. Calcium 1000mg/day; Vitamin D 600 IU/day
d. Calcium 1200mg/day; Vitamin D 800 IU/day
D
Immunization with live vaccines should NOT be done for at least ______ after receiving high doses of glucocorticoids?
a. 2 weeks
b. 1 week
c. 4 weeks
d. 3 weeks
C
Most topical steroids are classified as which pregnancy category?
a. A
b. B
c. C
d. D
C
Which of the following is classified as highly responsive to topical application of corticosteroids?
a. Parapsoriasis
b. Sarcoidosis
c. Atopic dermatitis in adults
d. Seborrheic dermatitis
D
Patients on anticipated oral glucocorticoid doses of ___mg for ___month/s or longer should be screened for tuberculosis.
a. 10mg; 2 months
b. 15mg; 1 month
c. 25 mg; 1 month
d. 20mg; 2 months
B
to ensure that the hypothalamicpituitary–adrenal (HPA) axis will not be suppressed, intralesional triamcinolone acetonide is best to limit a total monthly dose of how many mg?
20 mg
Possible local adverse reaction of IM steroid
lipoatrophy or sterile abscesses
In patients taking oral steroids, the diet should be low in _______ and high in ________
Diet should be low in calories, fat, and sodium, and high in protein, potassium, and calcium as tolerated
All patients anticipated to be on glucocorticoid doses of ______ or greater for 1 month or longer should be screened for tuberculosis with either a tuberculin skin test by injecting PPD or IGRA.
15 mg
Immunization with live vaccines can be done if the duration of glucocorticoid use is less than _______
- 2 weeks at any dose
- < 20 mg/day of any duration
- <less than 2 mg/kg in patients who weigh < 10 kg
- long-term alternate-day treatment with short-acting preparations (cortisol/ cortisone)
Immunization with live vaccines should not be done for at least ______ after receiving high doses of glucocorticoids (>20 mg/day) for more than 2 weeks.
1 month
Immunization with live vaccines should not be done for at least 1 month after receiving how many mg/day and for how long
high doses of glucocorticoids (>20 mg/day) for more than 2 weeks
Patients receiving daily glucocorticoid therapy for longer than __________must be assumed to have adrenal suppression that requires tapering of the glucocorticoids to allow for recovery of the HPA axis.
3 to 4 weeks
daily physiologic cortisol level
<5 mg prednisone/day; or 15 to 20 mg hydrocortisone/day
In testing the HPA axis, if the 8 AM plasma cortisol levels are 5 µg/dL or less, what will you do?
then continued glucocorticoid therapy and rechecking of the serum cortisol every 3 to 6 months until levels are higher than 10 µg/dL is required
Any patient anticipated to be on glucocorticoid therapy for 3 months or longer should receive what doses of Ca and Vit D?
calcium 1200 mg/day
vitamin D 800 International Units/day
What dose of prednisone and for how long is considered at high risk for ostreporosis?
prednisone 5 mg or more per day for 3 months or longer
- should be evaluated with dual-energy x-ray absorptiometry or by the World Health Organization (WHO)’s fracture risk assessment tool, the FRAX equation (http://www.shef.ac.uk/FRAX/), for consideration of initiation of bisphosphonates
If glucocorticoid therapy is limited to ______ weeks, the recovery of the HPA axis is rapid
1 to 3 weeks
Dose of prednisone that predisposes patient for steroid psychosis
> 80 mg/day
Diseases that are highly responsive to topical steroids
■ Atopic dermatitis (children)
■ Intertrigo
■ Psoriasis (intertriginous)
■ Seborrheic dermatitis
moderately responsive to topical steroid
■ Atopic dermatitis (adults)
■ Lichen simplex chronicus
■ Nummular eczema
■ Papular urticaria
■ Parapsoriasis
■ Primary irritant dermatitis
■ Psoriasis
Diseases that are least responsive to topical steroids
Allergic contact dermatitis, acute phase
Dyshidrotic eczema
Granuloma annulare
Insect bites
Lichen planus
Lupus erythematosus
Necrobiosis lipoidica diabeticorum
Palmoplantar psoriasis
Pemphigus
Psoriasis of nails
Sarcoidosis
Under normal conditions, how many percent of the applied topical steroid is therapeutically active
1%
Long acting corticosteroids
Dexamethasone and betamethasone
Steroid with highest mineralocorticoid potency
Fludrocortisone
Steroid with the longest plasma half-life
betamethasone (300 mins)
Steroid with the highest HPA suppression
Dexamethasone
Short-acting glucocorticoids
Cortisol and cortisone
Intermediate-acting CS
Prednisone, prednisoline, Triamcinolome, methylprednisolone
Long-acting CS
Dexamethasone and betamethasone
Mineralocorticoids
Fludrocortisone and desoxycorticosterone acetate
Hydrocortisone cross-reacts with what steroid?
Methylprednisolone aceponate
Methylprednisolone aceponate cross-reacts with what steroids?
Hydrocortisone and budesonide
