systemic corticosteroids and additional meds

Question 1

methylprednisolone dosage form

Answer 1

tablets
2,4,6,8,16,32 mg

Question 2

prednisolone dosage form

Answer 2

tablets - 5mg
oral liquid - 5mg/5mL and 15mg/5mL

Question 3

prednisone dosage form

Answer 3

tablets - 1,2.5,5,10,20, and 50 mg
oral liquid - 5mg/5mL

Question 4

dexamethasone dosage form

Answer 4

oral liquid - 1mg/mL and 0.5mg/5mL
tablets - 0.5, 1,4, and 6mg
injection - 4mg/mL and 10mg/mL

Question 5

methylprednisolone acetate dosage form

Answer 5

repository injection
40mg/mL
80mg/mL

Question 6

systemic corticosteroids

Answer 6

methylprednisolone
prednisolone
prednisone
dexamethasone
methylprednisolone acetate
decrease inflammation, increase response to b2 agonists

Question 7

burst methylprednisolone, prednisolone, and prednisone dosing for 0-4 yos

Answer 7

1-2 mg/kg/day

Question 8

burst methylprednisolone, prednisolone, and prednisone dosing for 5-11 yos

Answer 8

1-2 mg/kg/day as a single dose
2 divided doses for 3 to 5 doses

Question 9

burst methylprednisolone, prednisolone, and prednisone dosing for adults

Answer 9

40 to 60 mg/day as a single dose
2 divided doses for 3 to 5 days

Question 10

max of methylprednisolone, prednisolone, and prednisone dosing for 0-4 yos

Answer 10

under 2 yos - 20mg/day for 3 to 7 days
2 to 5 yos - 30mg/day for 3 to 7 days

Question 11

max of methylprednisolone, prednisolone, and prednisone dosing for 5-11 yos

Answer 11

40mg per day for 3 to 7 days

Question 12

max of methylprednisolone, prednisolone, and prednisone dosing for adults

Answer 12

60mg per day for 3 to 7 days

Question 13

burst dexamethasone dosing for 0-4 yos

Answer 13

0.6mg/kg for 1 dose IV or IM
0.6mg/kg for 2 days by mouth

Question 14

max dexamethasone dosing for 0-4 yos

Answer 14

16mg daily (IV or mouth)

Question 15

methylprednisolone acetate dosing for 0-4 yos

Answer 15

7.5mg/kg IM once
maximum of 240mg

Question 16

methylprednisolone acetate dosing 5-11 yos and adults

Answer 16

240mg IM for 1 dose

Question 17

adverse effects of systemic corticosteroids

Answer 17

short term use - hyperglycemia
increased appetite
fluid retention
demmargination of WBCs
psychiatric disturbances

Question 18

contraindications of systemic corticosteroids

Answer 18

systemic fungal infections
administration of live vaccines if immunocompromised

Question 19

drug interactions of systemic corticosteroids

Answer 19

warfarin INR levels increase
decreases efficacy of inactivated vaccines

Question 20

clinical pearls of systemic corticosteroids

Answer 20

may be used with ICS if patient is already taking ICS before hospitalization
may also be used for chronic therapy in both asthma and COPD only in severe stages
bursts effective for establishing control when initiating therapy or during period of gradual deteriorations
injection may be used in place of burst if adherence is an issue or the patient is vomiting

Question 21

sq b2 agonists

Answer 21

epinephrine
terbutaline

Question 22

epinephrine dosing for children

Answer 22

0.01mg/kg up to 0.3 to 0.5mg every 20 minutes for 3 doses sq

Question 23

epinephrine dosing for adults

Answer 23

0.3 to 0.5 mg every 20 minutes for 2 doses sq

Question 24

epinephrine comments

Answer 24

no proven advantage of systemic therapy over aerosol
indicated in addition to standard therapy for acute asthma associated with anaphylaxis and/or angioedema

Question 25

terbutaline dosing for children

Answer 25

0.01 mg/kg every 20 minutes for 3 doses then every 2 to 6 hours sq prn

Question 26

terbutaline dosing for adults

Answer 26

0.25mg every 20 minutes for 3 doses subcutaneously then prn

Question 27

terbutaline dosing comments

Answer 27

no proven advantage of systemic therapy over aerosol

Question 28

magnesium sulfate IV

Answer 28

smooth muscle relaxation through inhibition of calcium influx into smooth muscle cells

Question 29

magnesium sulfate dosing for children

Answer 29

25 to 75 mg/kg IV for 1 dose
maximum dose of 2gm

Question 30

magnesium sulfate dosing for adults

Answer 30

2 grams IV for 1 dose
infused over 20 minutes

Question 31

magnesium sulfate dosing comments

Answer 31

consider if patient remains in life threatening exacerbation after 1 hour of therapy

Question 32

adverse effects of magnesium sulfate

Answer 32

flushing
hypotension
vasodilation

Question 33

contraindications of magnesium sulfate

Answer 33

heart block
caution in renal dysfunction