Final Exam - Steroid Use Dermatology Flashcards
what is steroid tachyphylaxis?
sometimes the patient doesn’t respond to glucocorticoids anymore - if there is no reason for ineffectiveness, administer an equipotent dose of a different steroid
overtime - patient may respond to the original steroid (steroid tachyphylaxis)
what is the goal of using steroids in dermatology for treating patients?
reach clinical effect using the lowest dose of steroid as infrequently as possible - dose changes based on need & tolerance of patient
how do you aim your dosing with steroids for dermatological disease?
daily induction dose, followed by alternate day dosing, then every 3rd day - use intermediate acting steroids (prednisone & prednisolone) to achieve this dosing
why do horses & cats need prednisolone?
need the active drug because they lack glucoronidation
why do we do steroid injections for cats? what is the risk of this?
cats can be difficult to pill - depo shots
significant hemodynamic changes can occur - congestive heart failure
what are the caveats to managing an atopic dog with the lowest anti-inflammatory dose of prednisone every 2nd to 3rd day 4-5 months out of the year?
can’t have any infections
must be on flea prevention
periodic bathing
T/F: cats are less sensitive to the effects of steroids compared to dogs
true
why do you need to do a bacterial culture off of cystocentesis in a dog that has been on glucocorticoids for over 6 months?
UTIs are common in these dogs!!!
they are typically subclinical with no detectable bacteriuria or pyuria
what is absolutely required for managing a patient on long term steroid therapy?
exams at least twice a year!!!!!
cutaneous infections often occur while tapering steroids - must treat with topical/oral antibiotics (not more steroids!!!)
steroid sparing therapy if the dose is too high or disease can’t be controlled - flea prevention, shampoos, fatty acids, topical glucocorticoids, antihistamines, immunotherapy
steroid sparing meds need to be monitored with periodic CBCs & chemistry panels every 2-3 weeks for 3 months & then every 3 months after
refer refractory cases to a dermatologist
what is the initial induction dose needed for dogs for an anti-inflammatory/anti-pruritic effect? what about taper dose? maintenance dose?
induction - 0.5 - 1.0 mg/kg PO q 24 hours 3-10 days
taper - 0.5 - 1.0 mg/kg PO q 48 hours for 7-10 days
maintenance - 0.5 mg/kg PO q 48-72 hours for no more than 4-5 months out of the year
what are your long acting glucocorticoids?
dexamethasone - > 48 hours
betamethasone - > 48 hours
