Review of Steroids

Question 1

(T/F) Prednisone/prednisolone can be used for treatment of Addison’s alone.

Answer 1

(F, prednisone associated with a weak mineralocorticoid action, not adequate for treatment of Addison’s alone, DOCP or fludrocortisone is combined with prednisone for tx of Addison’s)

Question 2

What are the mechanisms of action that are excepted of glucocorticoids when given at an anti-inflammatory dose?

Answer 2

(Inhibition of phospholipase A2, decreased movement of WBCs into inflamed tissue (reduces release of cytokines), inhibition of release of inflammatory mediators and enzymes (histamine, bradykinin), and stabilization of microvascular integrity)

Question 3

What are the mechanisms of action that are expected of glucocorticoids when given at an immunosuppressive dose?

Answer 3

(Decreased macrophage and lymphocyte function, particularly T cells but chronic use will also reduce B cell activity eventually)

Question 4

What are some strategies that have been formed to minimize adverse effects associated with the use of glucocorticoids?

Answer 4

(Alternate day therapy, taper dosing/using minimum effective dose, alternative routes of administration (that decrease systemic absorption), and alternative therapeutic options; note that these only minimize, not prevent, ADEs)

Question 5

Which of the methylprednisolone formulations is meant for short duration use such as shock?

Answer 5

(Methylprednisolone sodium succinate aka Solu-medrol)

Question 6

What are some of the common uses of Depo-medrol (methylprednisolone acetate)?

Answer 6

(Given to cats difficult to treat with daily meds and for joint injections)

Question 7

For the following, state whether NSAIDs or glucocorticoids would be more useful as a treatment (although there is lots of overlap and exceptions):

• Immune-mediated dz
• DJD
• Fever
• Neurological disease and/or trauma
• Asthma
• Wounds
• Hypersensitivities
• Perioperative
• Shock
• Infections

Answer 7

• Immune-mediated dz (GCs)
• DJD (NSAIDs)
• Fever (NSAIDs)
• Neurological disease and/or trauma (GCs)
• Asthma (GCs)
• Wounds (NSAIDs)
• Hypersensitivities (GCs, more for severe hypersensitivity reactions)
• Perioperative (NSAIDs)
• Shock (GCs)
• Infections (NSAIDs)

Question 8

Why should you use caution when prescribing an oral solution of prednisolone to cats?

Answer 8

(Often comes in an alcohol based vehicle which can be toxic to cats; same goes for dexamethasone in PEG)

Question 9

Which dexamethasone formulation is meant for more emergent cases in which rapid IV administration is necessary?

Answer 9

(Dexamethasone SP (sodium phosphate salt), vehicle is water)