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7th > Chapter 184 - Glucocorticoids > Flashcards

Chapter 184 - Glucocorticoids Flashcards

1
Q

Complications are increased with (4)

A
  1. Fluorinated compounds
  2. Higher doses
  3. Longer duration of therapy
  4. More frequent administration
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2
Q

Essential component of therapy

A

Careful monitoring of systemic and cutaneous side effects

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3
Q

Major naturally occurring glucocorticoid

A

Hydrocortisone / cortisol

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4
Q

Daily cortisol production is ___ with a diurnal peak around ___ with plasma half life of ____

A

5-7 mg/m2
8am
90minutes

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5
Q

Glucocorticoids suppress monocyte and lymphocyte function (Th1 and Th2) more than polymorphonuclear lymphocyte function.
True or False

A

True, hence granulomatous diseases such as Tb are prone to exacerbation and relapse

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6
Q

B lymphocytes and plasma cells are not resistant to suppressive effects of glucocorticoids.
True or False

A

False, relatively resistant

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7
Q

The use of glucocorticoids is controversial in the treatment of: (4)

A

EN
LP
CTCL
DLE

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8
Q

Most common indications of systemic steroids: (9)

A 
Serious blistering diseases
CT diseases
Vasculitis
Neutrophilic dermatoses
Sarcoidosis
Type I reactive leprosy
Hemangioma of infancy
Panniculitis
Urticaria/Angioedema
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9
Q

For IL admin in conditions like keloids and aa, the ff drugs are used

A

Triamcinolone acetate (Aristospan) + Triamcinolone acetonide (Kenalog)

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10
Q

It is best to limit monthly dose of triamcinolone acetonide (Kenalog) to ___ to ensure that HPA axis will not be suppressed

A

20 mg

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11
Q

Disadvantages of IM admin: (2)

A

Erratic absorption

Lack of daily control of dose

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12
Q

ADE of IM inj: (2)

A

Lipoatrophy

Sterile abscesses

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13
Q

Short acting have more side effects than long-acting formulations
True or False

A

False

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14
Q

IM administration produce lasting effects up to ___

A

3 weeks

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15
Q

IV glucocorticoids are used in 2 situations:

A
  1. Acutely ill/undergoing surgery

2. Resistant PG, pemphigus, BP, severe SLE or DM

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16
Q

____ is used for its high potency and low sodium retaining activity

A

Methylprednisolone 500mg-1g OD

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17
Q

Serious side effects associated with IV administration (4)

A

Anaphylaxis
Seizures
Arrythmias
Sudden death

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18
Q

Most commonly prescribed oral glucocorticoid

A

Prednisone

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19
Q

For intermediate acting glucocorticoids, the ff have zero mineralocorticoid activity

A

Triamcinolone

Methylprednisolone

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20
Q

For long acting glucocorticoids, the ff have zero mineralocorticoid activity

A

Dexamethasone

Betamethasone

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21
Q

Examples of short acting glucocorticoids

A

Cortisol

Cortisone

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22
Q

Biologic half life of short-acting glucocorticoids

A

8-12h

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23
Q

Biologic half life of intermediate-acting glucocorticoids

A

18-36 hours

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24
Q

Biologic half life of long acting glucocorticoids

A

36-54h

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25
Q

Examples of mineralocorticoid

A

Fludrocortisone

Desoxycorticosterone acetate

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26
Q

Diet should be high in ___ (3)___and low in ___(3)___

A

Protein, potassium, calcium

Calories, fat, sodium

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27
Q

All patients taking glucocorticoids ___ or higher for ___ should be screened for Tb

A

15mg or higher

1 month

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28
Q

As glucocorticoids may downregulate delayed type hypersensitivity reactions, a PPD is considered positive if with ___ or more of induration

A

5mm

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29
Q

Immunization with live vaccines can be done if:

  1. Duration of glucocorticoid us is less than ____ weeks at any dose
  2. If dose of glucocorticoid is less than ____mg/day of any duration
  3. Less than ____ mg/kg in patients who weigh less than ___
  4. Long term alternate day treatment with____ acting preparation is used
A
  1. 2 weeks
  2. 20 mg/ day
  3. 2mg/kg, 10kg
  4. Short
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30
Q

Immunization with live vaccines should nit ve done for at least ___ after receiving high doses of glucocorticoids ____mg/day for more than ____

A

1 month
>20mg/day
2 weeks

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31
Q

Testing the HPA axis should be done with an 8am cortisol after tapering to dose less than or equal to physiologic cortisol level
Eg. ___/ day prednisone
_____/day hydrocortisone

A

<5mg

15 to 20 mg

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32
Q

With HPA axis testing, if

  1. ___ ug/dl or less, continue glucocorticoids therapy and rechecking of serum cortisol every ____ months until levels are higher than ___ug/dl is required
  2. ___ ug/dl or higher, but ___ ug/dl or less, perform further testing such as
A
  1. 5 ug/dl, 3 to 6 months, 10ug/dl

2. 5ug/dl, 20ug/dl, corticotropin releasing hormone stimulation test

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33
Q

Most complications are associated with higher doses, longer duration except for(3)

A
  1. Osteoporosis &; cataracts, alternate day dosing

2. Avascular necrosis, short courses

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34
Q

Even low doses if prednisone (___ mg/day) adversely affect bone and increase vertebral and hip fractures

A

2.5 mg/day

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35
Q

Osteoporosis occurs in ___% of individuals treated with long term systemic glucocorticoids

A

40%

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36
Q

Bone loss occurs more rapidly in the first few months of life
True or False

A

True

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37
Q

Any patient anticipated to be on glucocorticoid therapy for ___ months or longer should receive

A

3 mos

  1. Vit D 800 IU
  2. Ca 1200 mg/ day
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38
Q

The ff should be evaluated with DEXA for initiation of bisphosphonates

A
  1. Patients anticipated to be on prednisone 5mg or more for 3 months
  2. All ptients at high risk for osteoporosis
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39
Q

Rare side effects of bisphosphonates

A

Osteonecrosis of jaw

Atypical femoral fractures

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40
Q

Bisphosphonates are contraindicated in 1.patients with creatinine clearance below ____ml/min

  1. Who cannot sit upright for ___ after swallowing pill
  2. Patients with esophageal disorders
A

30

30 mins

41
Q

Long term use of glucocorticoids and/ or high risk patients may be evaluated for initiation of

A

Teriparatide

42
Q

Radiographs can be normal in avascular necrosis.

True or Flase

A

True

43
Q

Greatest risk for CV disease in patients with

A

Iatrogenic Cushing syndrome

44
Q

Symptoms of adrenal insufficiency despite normal cortisol response to ACTH

A

Steroid withdrawal syndrome

45
Q

For psychiatric side effects, women may be more likely to develop ___ whereas men may be more likely to develop ___

A

Depression

Mania

46
Q

The risk of depression, mania, delirium, confusion, and disorientation increases with age.
True or False

A

True

47
Q

The risk of suicidal behavior and panic disorder increases with age
True or False

A

False

48
Q

The incidence of neuropsychiatric events is higher in the ____ months of therapy

A

First 3 months

49
Q

Prednisone doses greater than ____mg/ day place patients at increased risk for steroid psychosis

A

80 mg/day

50
Q

Glucocorticoids are teratogenic.

True or False

A

False

51
Q

To decrease amount of drug transferred during breastfeeding: (2)

A
  1. Use prednisolone instead of prednisone

2. Avoid breastfeeding for 4 hours after a dose

52
Q

Glucocorticoid- induced osteoporosis is irreversible

True or False

A

False, reverse after DC of Tx

53
Q

Growth suppression can be reversed with treatment of ____

A

Growth hormone

54
Q

Effects of topical glucocorticoids: (3)

A

Antiinflammatory
Immunosuppressive
Antiproliferative
Vasoconstrictive

55
Q

Used to predict clinical activity of topical glucocorticoids

A

Vasoconstriction assays

56
Q

Examples of Class I - superpotent

A

Clobetasol propionate 0.05%
Halobetasol propionate 0.05%
Fluocinonide 0.1% optimized vehicle
Flurandrenolide 4ug/cm2

57
Q

Examples of Class II - Potent

A

Desoximethasone 0.25%

Halcinonide 0.1%

58
Q

Examples of Class III - Potent, Upper Midstrength

A

Fluticasone propionate 0.005%

Triamcinolone acetonide 0.5%

59
Q

Examples of Class IV- Midstrength

A 
Betamethasone valerate 0.12%
Clocortolone pivalate 0.1%
Desoximethasone 0.05%
Fluocinolone acetonide 0.025%
Hydrocortisone probutate 0.1%
60
Q

Examples of Class V - lower Midstrength

A

Hydrocortisone butyrate 0.1%

61
Q

Examples of Class 6- Mild strength

A

Aclometasone dipropionate 0.05%

Desonide 0.05%

62
Q

Class 7- Least potent

A 
Dexamthasone
Flumethasone
Hydrocortisone
Methylprednisolone
Prednisolone
63
Q

Radiographs can be normal in avascular necrosis.

True or Flase

A

True

64
Q

For psychiatric side effects, women may be more likely to develop ___ whereas men may be more likely to develop ___

A

Depression

Mania

65
Q

The risk of depression, mania, delirium, confusion, and disorientation increases with age.
True or False

A

True

66
Q

The risk of suicidal behavior and panic disorder increases with age
True or False

A

False

67
Q

The incidence of neuropsychiatric events is higher in the ____ months of therapy

A

First 3 months

68
Q

Prednisone doses greater than ____mg/ day place patients at increased risk for steroid psychosis

A

80 mg/day

69
Q

Glucocorticoids are teratogenic.

True or False

A

False

70
Q

To decrease amount of drug transferred during breastfeeding: (2)

A
  1. Use prednisolone instead of prednisone

2. Avoid breastfeeding for 4 hours after a dose

71
Q

Glucocorticoid- induced osteoporosis is irreversible

True or False

A

False, reverse after DC of Tx

72
Q

Growth suppression can be reversed with treatment of ____

A

Growth hormone

73
Q

Highly responsive to glucocorticoids

A

Atopic dermatitis (children)
Intertrigo
Psoriasis (intertrignous)
Seborrheic dermatitis

74
Q

Moderately responsive to topical application of corticosteroids (7)

A 
Atopic dermatitis (adults)
Lichen simplex chronicus
Nummular eczema
Papular urticaria
Parapsoriasis
Primary irritant dermatitis
Psoriasis
75
Q

A risk for LBW is associated with ___topical corticosteroids

A

High potency

76
Q

It is recommended to limit short term exposure to high potency corticosteroids while breastfeeding
True or False

A

False, long term

77
Q

Tachyphylaxis has been demonstrated by: (3)

A

Diminished vasoconstriction
Rebound of DNA synthesis
Recovery of histamine wheals

78
Q

___ should be avoided in infants and young children other than for short term application to decrease risk of systemic absorption

A

High potency preparations

Halogenated medium potency preparations

79
Q

Prominent and potential cutaneous ADE of glucocorticoids that involve epidermis and dermis

A

Skin atrophy

80
Q

Major glycosaminoglycan in the skin that is rapidly decreased after short term glucocorticoid treatment

A

Hyaluronan

81
Q

Reddish purplish granulomatous lesions in diaper area which is a well known complication of diaper dermatitis during treatment with corticosteroids

A

Granuloma gluteale infantum

82
Q

Classification of corticosteroids by cross reactivity

  1. Triamcinolone acetonide
  2. Clobetasol - 17- propionate
  3. Hydrocortisone -17- butyrate
  4. Budesonide
  5. Tixocortol -21-pivalate
A
  1. B
  2. D1
  3. D2
  4. B
  5. A
83
Q

Classification of corticosteroids by cross reactivity

  1. Methylprednisolone aceponate
  2. Betamethasone
  3. Triamcinolone acetonide
  4. Betamethasone dipropionate
  5. Hydrocortisone
A
  1. D2
  2. C
  3. B
  4. D1
  5. A
84
Q

Esophageal disorders wherein bisphosphonates are contraindicated (4)

A

Achalasia
Strictures
Reflux
Varices

85
Q

If multiple joints are involved in avascular necrosis, a ___ may be needed

A

Bone scan

86
Q

Glucocorticoid use is associated with increased risk for CV diseases like: (2)

A

Ischemic heart disease

Heart failure

87
Q

Increased CV risk may persist for years despite normalization of serum cortisol level.
True or False

A

True

88
Q

Symptoms of adrenal insufficiency: (3)

A

Orthostatic hypotension
Hypoglycemia
Weakness

89
Q

Symptoms of steroid withdrawal syndrome (5)

A 
Desquamation of skin
Headache
Malaise
Myalgia
Arthralgia
90
Q

Side effects of glucocorticoids in the pediatric population (2)

A

Growth suppression

Early osteoporosis

91
Q

Mechanism of antiproliferative effects of steroids (3)

A

Inhibition of DNA synthesis and mitoses
Reduce keratinocyte size and proliferation
Inhibits fibroblast activity and collagen formation

92
Q

Clinical response to a formulation is directly proprotional to ___ of corticosteroid achieved at target site.

A

Concentration

93
Q

Most topical steroids are USFDA Category __

A

C

94
Q

___ steroid under occlusion is usually required for hyperkeratotic or lichenified dermatoses

A

Very potent steroid

95
Q

Potential allergens in topical corticosteroids vehicles (7)

A 
Formaldehyde-releasing preservatives
Fragrance
Lanolin
Methylchloroisothiazolinone
Parabens
Propylene glycol
Sorbitan sequioleate
96
Q

In patients on concomitant NSAIDS therapy, initiate prophylaxis with a __

A

PPI

97
Q

Consideration may be given to high dose glucocorticoids (___) for patients undergoing major surgical procedures or patients with primary adrenal failure, congenital adrenal hyperplasia, or hypopituitarism

A

50 mg hydrocortisone every 8 hours until tolerating oral intake

98
Q

Attention must be paid to patients on high doses of glucocorticoids with underlying lung disease, low lymphocyte counts, underlying conditions further contributing to immunosuppression, and/ or patients on concomitant cytotoxic therapies, as these patients are at increased risk for development of

A

Pneumocystis pneumonia

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