Corticosteroid Dosing + Regimens Flashcards
The goal with CS dosing is to…
Bring inflammation/immunologic reactions under control with MED
MED stands for…
Minimal effective dose
Dose of CS will depend on…
Specific situation to balance disease activity + toxicity
Clinical experience
Initial dosing regimen with CS is usually…
OD or BID
Maintenance dosing for CS is usually…
How often
Once daily
Are there guidelines for CS dosing?
NO set guidelines !
It is important to use CS for the shortest amount of time possible because…
CS’s have adverse effects with chronic use !
CS’s may need to be tapered upon discontinuation if…
HPA-axis suppression is suspected
If on a short-term CS for less than 3 weeks, taper…
May not be necessary
Ways that CS can be tapered include…
Decreasing daily dose by set amounts every few days/weeks
Decreasing daily dose by %
During a taper, when reaching 5mg prednisone, doses might be converted to…
Hydrocortisone 20mg, then see a further taper
Transitioning from a divided dose to once daily dosing should be done…
Over a 2 week period, if divided dosing has been done for 2+ weeks
Can convert ASAP if done for less than 2 weeks
Ultimate goal of tapering in all situations is to…
Avoid rapid steroid withdrawal side effects
HPA-axis suppression; monitor for these during tapering
Due to CS biological half-life, CS could be dosed…
EOD - every other day
EOD dosing may be beneficial, because it is theroretically…
Side fx?
Less suppressive of HPA axis
When doing EOD, we want to use CS with…
Duration of action?
Short-immediate duration of action to minimize accumulation
Situations where we may see EOD dosing include…
When chronic administration is ncessary
When children require maintenance dosing
MED is determined by…
Tapering the current daily dose by 2.5-5mg/week, until flares are reached
The conversion strategy to EOD dosing involves the following steps…
Determining MED; optimal EOD is 2.5-3x the MED.
Alternate optimal EOD dose with MED, then taper MED dose by 5mg/week, then taper current dose by 5mg/week to achieve new MED
Stress dosing of CS is when…
CS doses may habe to be supplemented in certain situations, like surgery or illness
Body cannot produce enough cortisol for emergency situations
Amount and duration of stress dosing depends on…
Pre-op dose of steroid taken by patient, Pre-op duration of steroid administration, or nature of illness/surgery
Do minor procedures require stress dosing?
No extra supplementation
Major surgeries requires stress dosing of…
HC 100mg IV pre-surgery, then 100mg q8h for 24 hours
Taper rapidly by 50% daily to MD
Does moderate illness requires stress dosing?
Yes - HC 50mg PO/IV BID for a few days
Rapidly taper to maintenance dose as recovering
Steroid pulse therapy is the administration of…
Short term, high-dose IV/PO steroids in situations where rapid remission of serious conditions is desired
Advantages of steroid pulse therapy include…
More rapid control of condition
Help avoid certain adverse effects; not prolonged CS therapy
Disadvantages of steroid pulse therapy are that…
Certain adverse effects such as hypertension, infection, seizures, and psychosis may be more likely and significant
