Corticosteroid Dosing Flashcards
Is there set guidelines for CS dosing?
There is no set guidelines
What is the goal of CS dosing? What is considered in a dose?
Goal is to bring inflammation or immunologic reactions under control with the MED (minimal effective dose)
- Need to balance disease activity and toxicity
- Dose will depend on the specific situation and clinical experience
Dosing regimen of initial dosing
OD or BID
Dosing regime of maintenance dosing
OD
What is the normal range of dosing for prednisone:
0.5-1 mg/kg/day
CS’s duration recommendation?
CS’s have AE’s with chronic use, so it’s best to use for shortest amount of time if possible
Can CS’s be discontinued automatically?
No
Corticosteroids may need to be tapered upon discontinuation if HPA-axis suppression is suspected
When would tapering of a corticosteroid not be necessary?
If on a short-term CS for <3 weeks – taper may not be necessary
How can one taper CS?
May ↓ daily dose by set amounts every few days / weeks
E.g. ↓ by 1mg to 2.5mg to 5mg prednisone q 3-7days
Decrease depends on starting point
Or may ↓ daily dose by a percentage. I.e. 5-10% per week
What may happen when you reach 5 mg prednisone?
When reach 5mg prednisone – may see conversion to HC 20mg and then a further taper (equivalent potency –same dose) –> can then decrease the hydrocortisone
If someone is on a divided dose therapy, what are the recommendations to going to OD dosing?
Divided dose < 2weeks: convert ASAP
Divided dose > 2 weeks: convert over a 2 week period
What is the ultimate goal of tapering? What should be monitored?
Ultimate goal of tapering in all situations is to avoid rapid steroid withdrawal sx’s
As tapering occurs, monitor for flares/stress
IS alternate day dosing (EOD) possible with CS’S. If so, why is it possible, what is the benefit, and which CS’s are used?
Due to their biological t½, CS’s can be dosed EOD
EOD will theoretically be less suppressive of HPA Axis. Minimize a/e on growth, chance of infections
Want to use a CS with a short-intermediate D of A to minimize accumulation which could negate EOD benefits
What are some situations you may see EOD dosing being used?
Chronic administration necessary
Children requiring maintenance dosing
How can one calculate EOD dosing?
Determine minimal effective daily dose
Taper current daily dose by 2.5 – 5mg /week until MED is achieved
E.g. 30, 25,20,15
The optimal EOD dose is 2.5 – 3x the MED
E.g. 15 mg x 3 = 45 mg
Alternate the new calculated dose with MED
Taper the MED dose by 5mg/week until removed
E.g. 45/15 45/10 45/0
Taper current dose by 5mg/week to the lowest dose that controls sx’s (achieve a new MED)
E.g. 45/0 40/0 35/0 30/0
What is the goal of alternate day dosing?
Every other day dosing at the lowest effective dose
Define stress dosing of corticosteroids. Whaqt does the dose depend on?
CS doses may have to be supplemented in some situations in someone on long-term CS’s.
Amount & duration of stress dose depends upon:
Pre-op dose of steroid taken by patient
Pre-op duration of steroid administration
Nature of the illness or surgery
What are some stress-dosing examples?
Minor procedures (with local anesthesia): no extra supplementation
Moderate illness: HC 50mg po/IV bid- rapidly taper to maintenance dose (MD) as recover
Major surgery: HC 100mg IV pre-surgery, then 100mg q8h x 24h. Taper rapidly (by 50% daily) to MD
What is steroid pulse therapy? Examples of conditions? Are the dosing regimens the same?
The administration of short term, high-dose, IV or PO steroids in various situations (i.e. juvenile RA, nephrotic syndrome) where rapid remission of serious conditions is desired
There are considerable variations in dosing regimens
What are some examples of steroid pulse therapy?
Methylprednisolone 20/30mg/kg IV (max 1000mg) at intervals of every 24-48hrs; usually for 3-6 pulses
Acute MS relapse: 1250mg prednisone po x3-5d – equivalent to parenteral dosing
What are some advantages of steroid pulse therapy?
More rapid control of condition
Help avoid AE’s by avoiding prolonged steroid therapy (cumulatively less toxic) – steroid sparing effects?!
What are some disadvantages of steroid pulse therapy?
Certain adverse effects may be more likely and significant
Examples:
hypertension
Infection
Seizure
Psychosis
