Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PHRM 825 - Exam 3 > LECTURE 33 & 34: therapeutics of corticosteroids > Flashcards

LECTURE 33 & 34: therapeutics of corticosteroids Flashcards

1
Q

What happens if a patient abruptly stops taking a high dose of corticosteroids?

A

adrenal insufficiency – contraindication !!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the physiologic dose of hydrocortisone?

A

20mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the physiologic dose of prednisone?

A

5 - 7.5 mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the physiologic dose of dexamethasone?

A

0.75mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the physiologic dose of methylprednisolone?

A

4mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the pharmacologic dose?

A

Any doses greater than physiologic dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the maintenance/low dose of prednisone?

A

~ 5 - 15 mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the moderate dose of prednisone?

A

~0.5 mg/kg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the high dose of prednisone?

A

~ 1 - 3 mg/kg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the massive dose of prednisone?

A

~15 - 30 mg/kg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the principle for prescribing corticosteroids?

A

prescribe the lowest dose to achieve the desired effects → for the shortest duration possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the process of prescribing corticosteroids for pain/distressing symptoms

A

Start with lower dose
May gradually reduce dose until worsening symptoms → lowest acceptable dose
Substitute with other medications (e.g. NSAIDs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the process of prescribing corticosteroids for treatment of life-threatening conditions

A

Initial dose must be high
No benefits observed quickly → double/triple dose
Reserve high dose, long therapy for life threatening diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should patients on HIGH DOSE glucocorticoid NEVER receive?

A

live vaccine(s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List the equivalent doses to hydrocortisone

A

Hydrocortisone 20mg
Cortisone 25mg
Prednisone 5mg
Methylprednisolone 4mg
Dexamethasone 0.75mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 2 types of cushing’s syndrome?

A

endogenous and exogenous hypercortolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is endogenous cushing’s syndrome caused by?

A

Supraphysiologic cortisol concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the cause of exogenous hypercortisolism

A

Pharmacological doses of glucocorticoids
- drug induced
- nonprescription & herbal products
- etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the most common mode of delivery of glucocorticoids that has been implicated in drug-induced cushing’s syndrome?

A

oral delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the clinical presentation of cushing’s syndrome (hypercortisolism)

A

Redistribution of body fat (central obesity)
Moon facies
Thick neck
Buffalo hump & supraclavicular fat accumulation
Muscle wasting & weakness (steroid myopathy)
Easy bruising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

List factors that likely indicate that a patient requires a steroid taper.

A
  • Receive glucocorticoid dose equivalent to prednisone >/= 7.5 mg/day for long-term (> 3 weeks)
  • Receive evening dose of prednisone >/= 5mg for more than a few weeks
  • Patients with Cushingoid appearance
  • Cautious in frail or dangerously ill patients
  • Evaluate HPA function - not necessary
  • Ultimate end point: monitor pts signs & symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

List key therapy monitoring paraments for patients with adrenal insufficiency

A
  • Subjective well-being of the pt is an important clinical parameter in primary and secondary disease
  • Resolution of hypotension, dizziness, dehydration, hyponatremia, hyperkalemia
  • Monitor for adverse reactions of steroid
  • Maintenance of normal weight
  • Blood Pressure
  • Electrolytes with regression of clinical features
  • Adjust doses accordingly as needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

List some signs that a patient with adrenal insufficiency is experiencing under-replacement

A

weight loss
fatigue
nausea
myalgia (lack of energy)

24
Q

List some signs that a patient with adrenal insufficiency is experiencing over-replacement (cushing syndrome)

A

weight gain
central obesity
stretch marks
osteopenia/osteoporosis
impaired glucose tolerance
high blood pressure

25
Q

List some key counseling points for patients with adrenal insufficiency

A

Take with meals (or milk)
Do NOT stop therapy w/o seeking healthcare provider’s advice
Increase the dose of glucocorticoid during excessive physiologic stress
Double maintenance dose in the presence of fever, invasive dental procedure or diagnostic procedures, or surgery
How to administer parenteral glucocorticoid if unable to immediately access medical care during an emergency
Need to wear or carry medical identifiers (eg. card, necklace, bracelet)
Causes of adrenal insufficiency, including drug-induced etiologies
How to recognized the clinical manifestations
How to prevent an acute adrenal crisis

26
Q

Describe the tapering process for glucocorticoids

A
  • Gradually taper the dose to prednisone ~20mg (or equivalent) daily, given in AM
  • There is not much clinical evidence to support any particular tapering regimen, so, generally, aim for a relatively stable taper
  • 10-20% of total daily dose (5-10% every 1-4 weeks)
  • Accommodate convenience
  • Consider individual patient response
  • Then, change steroid to every other day administration
  • Stop steroid when equivalent physiologic dose is reached
27
Q

List the types of drugs that, when taken concurrently, could impact the metabolism of steroids

A

Drugs that strongly inhibit/induce P-glycoprotein transporters & CYP450 3A4

28
Q

List examples of CYP450 3A4 inducers

A

phenytoin, rifampin, barbiturates, carbamazepine

29
Q

List examples of CYP450 3A4 inhibitors

A

protease inhibitors, antifungals

30
Q

How should the steroid dose be adjusted if the patient is taking CYP450 3A4 inducers?

A

heavily increase dose of glucocorticoids in presence of inducers

31
Q

How should the steroid dose be adjusted if the patient is taking CYP450 3A4 inhibitors?

A

heavily decrease dose of glucocorticoids in presence of inhibitors

32
Q

List possible complications that patients taking exogenous glucocorticoids may experience

A

Infections
Myopathy
Osteonecrosis
Osteoporosis
Psychiatric symptoms
Fluid & Salt retention
Metabolic changes
Gastric ulcer
Cataract
Cardiovascular risks

33
Q

What should be monitored to prevent an infection complication for patients taking exogenous glucocorticoids?

A

signs & symptoms of all infections

34
Q

What should be monitored to prevent a myopathy complication for patients taking exogenous glucocorticoids?

A

muscle weakness

35
Q

What should be monitored to prevent an osteonecrosis complication for patients taking exogenous glucocorticoids?

A

hip, shoulder, knee pain

36
Q

What should be monitored to prevent an osteoporosis complication for patients taking exogenous glucocorticoids?

A

bone loss (DEXA scan), height, fractures, pain

37
Q

What should be monitored to prevent a psychiatric complication for patients taking exogenous glucocorticoids?

A

nervousness, anxiety, euphoria, insomnia, mood swings, depression, personality changes, poor concentration, poor memory, overt psychosis, hallucinations

38
Q

What should be monitored to prevent a fluid & salt retention complication for patients taking exogenous glucocorticoids?

A

blood pressure, edema, electrolytes

39
Q

What should be monitored to prevent a metabolic changes complication for patients taking exogenous glucocorticoids?

A

fasting blood sugar, weight, cholesterol, excessive thirst, frequent urination, fatigue, weight loss/gain

40
Q

What should be monitored to prevent a gastric ulcer complication for patients taking exogenous glucocorticoids?

A

burning pain, bloating, heartburn, nausea, vomiting, dark/black stools, vomiting blood, weight loss

41
Q

What should be monitored to prevent a cataract complication for patients taking exogenous glucocorticoids?

A

screen before treatment, 3 months after treatment, and yearly

42
Q

What should be monitored to prevent a cardiovascular complication for patients taking exogenous glucocorticoids?

A

blood pressure, heart rate, edema, cholesterol

43
Q

How should an infection complication be managed for a patient taking exogenous glucocorticoids?

A
  • treat infection aggressively
  • rinse mouth with inhaled steroid
44
Q

How should a myopathy complication be managed for a patient taking exogenous glucocorticoids?

A

physical activity

45
Q

How should an osteonecrosis complication be managed for a patient taking exogenous glucocorticoids?

A
  • discontinue/decrease therapy
  • joint replacement therapy
46
Q

How should an osteoporosis complication be managed for a patient taking exogenous glucocorticoids?

A
  • supplement with Calcium + Vitamin D
  • weight bearing exercises
  • avoid smoking
  • treat with bisphosphate or others
47
Q

How should a psychiatric complication be managed for a patient taking exogenous glucocorticoids?

A

decrease dose or discontinue agent, if possible

48
Q

How should a fluid & salt retention complication be managed for a patient taking exogenous glucocorticoids?

A
  • treat edema & HTN
  • reduce salt intake
  • supplement with K (if needed)
49
Q

How should a metabolic changes complication be managed for a patient taking exogenous glucocorticoids?

A
  • diet
  • hypoglycemia agents
  • insulin (short-term)
50
Q

How should a gastric ulcer complication be managed for a patient taking exogenous glucocorticoids?

A
  • prophylaxis with proton pump inhibitor or H2 receptor antagonist
  • avoid large doses of antacids
51
Q

How should a cataract complication be managed for a patient taking exogenous glucocorticoids?

52
Q

How should a cardiovascular complication be managed for a patient taking exogenous glucocorticoids?

A

treat as indicated

53
Q

Describe the onset of chronic adrenal insufficiency

54
Q

Describe the symptoms of chronic adrenal insufficiency

A

weakness & fatigue
anorexia, nausea, and diarrhea
hypoglycemia
amenorrhea
salt craving (22%)

55
Q

Describe the signs of chronic adrenal insufficiency

A
  • weight loss
  • orthostatic htn (<110/70 mmHg)
  • dehydration (hypo-Na, Hyper K+)
  • personality changes (irritability & restlessness)
  • loss of auxiliary & pubic hair for women
  • blood count abnormalities
  • hyperpigmentation of skin & mucous membranes

PHRM 825 - Exam 3 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions