chen lecture

Question 1

How do we find dose of corticosteroids

Answer 1

Trial and error

Question 2

Taking one or only a few doses of corticosteroid is harmful

Answer 2

No, even with big doses it wll be fine

Question 3

Abrupt cessation of prolonged high dose corticosteroids leads to

Answer 3

adrenal insufficiency

Question 4

T/F we do not administer corticosteroids unless absolutely indicated or more conservative measures have failed

Answer 4

true

Question 5

What are the dosage conversions for commonly used glucocorticoids

Answer 5

Hydrocortisone- 20 mg
cortisone 25 mg
prednisone- 5 mg
Methyl-prednisone- 4 mg
dexamethasone- 0.75 mg

Question 6

Conversion for cortisone

Answer 6

25

Question 7

conversion for hydrocortisone

Answer 7

20

Question 8

conversion for dexamethasone

Answer 8

0.75

Question 9

conversion for prednisone

Answer 9

5 mg

Question 10

conversion for methylprednisone

Answer 10

4 mg

Question 11

why do we dose glucocorticoids in the AM

Answer 11

They follow circadian cycle

Question 12

What are some live vaccines to avoid when taking glucocorticoids (unless it is replacement therapy)

Answer 12

MMR, live influenza, yellow fever.

Question 13

clinical presentations of cushings syndrome

Answer 13

easy bruising, redistribution of fat, loss of muscle, moon face, hump

Question 14

Which patients will be required to taper off corticosteroid?

Answer 14

equivalent dose of 7.5 or greater for prednisone for more than 3 weeks.

or evening dose of 5 mg prednisone or higher

Question 15

Do we need to taper off a high dose corticosteroid if we were on it for less than 3 weeks

Answer 15

NO

Question 16

signs and symptoms of patients with adrenal insufficiency

Answer 16

Pigmentation of skin
weight loss
fatigue and weakness
dehydration
Salt cravings

Question 17

What kind of drugs to we avoid in adrenal insufficiency?

Answer 17

Drugs that induce steroid metabolism

Question 18

What are the steroid metabolism inducing drugs that we should avoid if adrenal insufficient?

Answer 18

CYP 450 3A4 drugs

Question 19

What are some CYP450 3A4 drugs?

Answer 19

phenytoin, rifampin, barbiturates, carbamezapine

Question 20

What drugs should we avoid when treating cushing syndrome

Answer 20

Drugs that inhibit glucocorticoid metabolism, (Cyp 450 3A4 inhibitors, protease inhibitors, antifungals

Question 21

What are the 5 S’s of adrenal crisis management

Answer 21

Steroids, salt, sugar, support (IV), search for underlying cause