Corticosteroids Flashcards
Corticosteroids MOA
Anti-inflammatory
Corticosteroids formulations
IV, PO, rectal
Corticosteroids indication
Induce remission–>NOT FOR MAINTENANCE
Goal is to get off corticosteroids ASAP
Hydrocortisone formulations
suppositories, foams, enemas
Hydrocortisone PK
may still have some systemic exposure with topical use
Budesonide formulation
PO via controlled release
Budesonide PK
Extensive first pass metabolism with minimal systemic exposure
Metabolized hepatically via CYP3A4
Budesonide drug interactions
CYP3A4 inhibitors: ketoconazole, grapefruit juice
Prednisone/prednisolone formulation
PO
Prednisone/prednisolone pearls
TAPER
5-10 mg/week until dose of 20 mg/day is reached, then taper 2.5 mg/week
Methylprednisolone/hydrocortisone formulation
IV
Methylprednisolone/hydrocortisone side effects
Short term: Hyperglycemia, GI discomfort, Elevated BP, mood changes
Long term: aseptic necrosis, cataracts, obesity, HPA suppression, osteoporosis
Calcium + vitamin D while on steroids
Consider bisphosphonates if high risk, >3 month use, or recurrent users
Monitoring
DEXA scan if > 60 yo, high risk, > 3 month use, or recurrent users
Blood pressure
Blood glucose–>baseline and q3-6 months
