Corticosteroid Dosing + Regimens

Question 1

The goal with CS dosing is to…

Answer 1

Bring inflammation/immunologic reactions under control with MED

Question 2

MED stands for…

Answer 2

Minimal effective dose

Question 3

Dose of CS will depend on…

Answer 3

Specific situation to balance disease activity + toxicity
Clinical experience

Question 4

Initial dosing regimen with CS is usually…

Answer 4

OD or BID

Question 5

Maintenance dosing for CS is usually…

How often

Answer 5

Once daily

Question 6

Are there guidelines for CS dosing?

Answer 6

NO set guidelines !

Question 7

It is important to use CS for the shortest amount of time possible because…

Answer 7

CS’s have adverse effects with chronic use !

Question 8

CS’s may need to be tapered upon discontinuation if…

Answer 8

HPA-axis suppression is suspected

Question 9

If on a short-term CS for less than 3 weeks, taper…

Answer 9

May not be necessary

Question 10

Ways that CS can be tapered include…

Answer 10

Decreasing daily dose by set amounts every few days/weeks
Decreasing daily dose by %

Question 11

During a taper, when reaching 5mg prednisone, doses might be converted to…

Answer 11

Hydrocortisone 20mg, then see a further taper

Question 12

Transitioning from a divided dose to once daily dosing should be done…

Answer 12

Over a 2 week period, if divided dosing has been done for 2+ weeks

Can convert ASAP if done for less than 2 weeks

Question 13

Ultimate goal of tapering in all situations is to…

Answer 13

Avoid rapid steroid withdrawal side effects

HPA-axis suppression; monitor for these during tapering

Question 14

Due to CS biological half-life, CS could be dosed…

Answer 14

EOD - every other day

Question 15

EOD dosing may be beneficial, because it is theroretically…

Side fx?

Answer 15

Less suppressive of HPA axis

Question 16

When doing EOD, we want to use CS with…

Duration of action?

Answer 16

Short-immediate duration of action to minimize accumulation

Question 17

Situations where we may see EOD dosing include…

Answer 17

When chronic administration is ncessary
When children require maintenance dosing

Question 18

MED is determined by…

Answer 18

Tapering the current daily dose by 2.5-5mg/week, until flares are reached

Question 19

The conversion strategy to EOD dosing involves the following steps…

Answer 19

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

Question 20

Stress dosing of CS is when…

Answer 20

CS doses may habe to be supplemented in certain situations, like surgery or illness

Body cannot produce enough cortisol for emergency situations

Question 21

Amount and duration of stress dosing depends on…

Answer 21

Pre-op dose of steroid taken by patient, Pre-op duration of steroid administration, or nature of illness/surgery

Question 22

Do minor procedures require stress dosing?

Answer 22

No extra supplementation

Question 23

Major surgeries requires stress dosing of…

Answer 23

HC 100mg IV pre-surgery, then 100mg q8h for 24 hours

Taper rapidly by 50% daily to MD

Question 23

Does moderate illness requires stress dosing?

Answer 23

Yes - HC 50mg PO/IV BID for a few days

Rapidly taper to maintenance dose as recovering

Question 24

Steroid pulse therapy is the administration of…

Answer 24

Short term, high-dose IV/PO steroids in situations where rapid remission of serious conditions is desired

Question 25

Advantages of steroid pulse therapy include…

Answer 25

More rapid control of condition
Help avoid certain adverse effects; not prolonged CS therapy

Question 26

Disadvantages of steroid pulse therapy are that…

Answer 26

Certain adverse effects such as hypertension, infection, seizures, and psychosis may be more likely and significant