Chapter 76 Glucocorticoids

Question 1

Glucocorticoids are identical to what and why?

Answer 1

Steroids d/t its production from the adrenal cortex.

Question 2

At what doses are Glucocorticoids producing effects?

Answer 2

Low doses –> PHYSIOLOGIC EFFECTS (modulation of glucose metabolism in adrenal insufficiency)
High doses –. PHARMACOLOGIC EFFECTS (decrease inflammation)

Question 3

What is the pharmacology of glucocorticoids?

Answer 3

Receptors are INSIDE cells
Modulate the production of regulatory proteins compared to signaling pathways
CAN INCREASE GLUCOSE LEVELS
Anti-inflammatory and immunosuppressant effects

Question 4

When would you use a glucocorticoids? Best admin choice?

Answer 4

Rheumatoid arthritis (RA) w/ acute exacerbations
Reduce inflammation and pain but does not alter course
AVOID systemic use (use injectables to decrease long term steroid use/toxicity risk)

Question 5

What is a VERY common a/e with use of glucocorticoids?

Answer 5

Adrenal suppression (insufficiency) when you are intaking excess exogenous GC your body suppresses the production thus reducing the exogenous production of GC from the adrenal gland.
Osteoporosis (ribs and fractures) -hypocalcemia, reduction of calcium from bone to supply body

Question 6

What is a common drug interactions with glucocorticoids? Why?

Answer 6

K+ loss (hypokalemia) - if a patient is on digoxin/diuretics, increased risk of dysrhythmias

Over time, chronic use of GC can reduce potassium by wasting it within excretion as GCs have similar effects to mineralcorticoids holding onto Na+ and reducing K+.

Question 7

What precautions/contraindications would you warn your patient about while using glucocorticoid? Why?

Answer 7

CONTRAINDICATIONS - systemic fungal infx, live vaccine use

Immunosuppression a/e r/t GC use.

Question 8

What method would you use to reduce the risk of withdrawal in a patient taking glucocorticoids?

Answer 8

Taper the dose over 7 days if used longer than 2-3 weeks
Switch from multiple doses to single doses
Taper dose to 50% of physiologic value

Question 9

When would tapering be unnecessary for a glucocorticoid?

Answer 9

When ORAL glucocorticoids have been used for less than 2-3 weeks

Question 10

How do you dose a glucocorticoid?

Answer 10

Determined empirically (trial and error)
No immediate threat - start low and slow
Immediate threat - start high and decrease as possible
Long term - smallest effective amount
Prolonged tx - if life threatening or has potential to cause permanent disability

Question 11

What is alternative day therapy? Why do we do it? What are considerations for this frequency of therapy?

Answer 11

Large dose intermediately is given every other morning if the patient is stable to help with:

1. Reducing growth delay in children
2. Toxicity
3. Reducing adrenal suppression

Considerations - admin before 9 in the morning, may cause a flare up of symptoms between dosing intervals