28 - 184 - GLUCOCORTICOIDS

Question 1

Percutaneous absorption process occurring in the epidermis, except

a. Diffusion

b. Metabolism

c. Binding

d. Reservoir function

Answer 1

D

Question 2

Which is NOT an intermediate-acting systemic glucocorticoid?

a. cortisone

b. prednisone

c. methylprednisolone

d. prednisolone

Answer 2

A

Short-acting
Cortisone
Cortisol

Intermediate acting:
Prednisone
Prednisolone
Triamcinolone
Methylprednisolone

Long-acting
Dexamethasone
Betamethasone

Question 3

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

Answer 3

D

Question 4

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

Answer 4

C

Question 5

Most topical steroids are classified as which pregnancy category?

a. A

b. B

c. C

d. D

Answer 5

C

Question 6

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

Answer 6

D

Question 7

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

Answer 7

B

Question 8

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?

Answer 8

20 mg

Question 9

Possible local adverse reaction of IM steroid

Answer 9

lipoatrophy or sterile abscesses

Question 10

Question 11

Question 12

Question 13

In patients taking oral steroids, the diet should be low in _______ and high in ________

Answer 13

Diet should be low in calories, fat, and sodium, and high in protein, potassium, and calcium as tolerated

Question 14

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.

Answer 14

15 mg

Question 15

Question 16

Immunization with live vaccines can be done if the duration of glucocorticoid use is less than _______

Answer 16

• 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)

Question 17

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.

Answer 17

1 month

Question 18

Immunization with live vaccines should not be done for at least 1 month after receiving how many mg/day and for how long

Answer 18

high doses of glucocorticoids (>20 mg/day) for more than 2 weeks

Question 19

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.

Answer 19

3 to 4 weeks

Question 20

daily physiologic cortisol level

Answer 20

<5 mg prednisone/day; or 15 to 20 mg hydrocortisone/day

Question 21

In testing the HPA axis, if the 8 AM plasma cortisol levels are 5 µg/dL or less, what will you do?

Answer 21

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

Question 22

Question 23

Any patient anticipated to be on glucocorticoid therapy for 3 months or longer should receive what doses of Ca and Vit D?

Answer 23

calcium 1200 mg/day
vitamin D 800 International Units/day

Question 24

What dose of prednisone and for how long is considered at high risk for ostreporosis?

Answer 24

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

Question 25

If glucocorticoid therapy is limited to ______ weeks, the recovery of the HPA axis is rapid

Answer 25

1 to 3 weeks

Question 26

Dose of prednisone that predisposes patient for steroid psychosis

Answer 26

> 80 mg/day

Question 27

Question 28

Diseases that are highly responsive to topical steroids

Answer 28

■ Atopic dermatitis (children)

■ Intertrigo

■ Psoriasis (intertriginous)

■ Seborrheic dermatitis

Question 29

moderately responsive to topical steroid

Answer 29

■ Atopic dermatitis (adults)

■ Lichen simplex chronicus

■ Nummular eczema

■ Papular urticaria

■ Parapsoriasis

■ Primary irritant dermatitis

■ Psoriasis

Question 30

Diseases that are least responsive to topical steroids

Answer 30

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

Question 31

Question 32

Under normal conditions, how many percent of the applied topical steroid is therapeutically active

Answer 32

1%

Question 33

Question 34

Question 35

Question 36

Question 37

Long acting corticosteroids

Answer 37

Dexamethasone and betamethasone

Question 38

Steroid with highest mineralocorticoid potency

Answer 38

Fludrocortisone

Question 39

Steroid with the longest plasma half-life

Answer 39

betamethasone (300 mins)

Question 40

Steroid with the highest HPA suppression

Answer 40

Dexamethasone