Use of Glucocorticoids in Clinical Practice Flashcards
What is the most potent anti-inflammatory agent?
Glucocorticoids
Give 8 indications for steriods…
- Allergic disease
- Immune-mediated disease
- HypoAC
- Neoplasia
- Shock
- Cerebral and SC oedema
- Profound inflammatory disorders
- Hypercalcaemia
Outline the use of glucocorticoids for treating allergic disease…
Lowest dose and shortest acting agent possible
+/- dietary modifications
Use alternative where possible e.g. apoquel
How do prednisolone and prednisone differ?
Prednisone is the inactive precursor of prednisolone.
Outline the steroid induction of remission phase when treating I-M disease
Once daily, high dose
2-4mg/kg/d in dogs
(1.5x in cats) for - 10 days
2mg/kg/g for further 10 days
Outline the steroid maintenance of remission phase when treating I-M disease
Starts after 20 days of induction
2mg/kg/2d
Concurrent non-steroid immunosuppressants q2d
taper 2-4wks
Which non-steroid immunosuppresent are used in the dog and cat?
Dog: Azathioprine
Cat: Chlorambucil
Do all sized dogs get the same dose of glucocorticoids? Why?
No - drug distribution is related linearly to body surface area not weight.
Dogs >30kg shoud be dosed at 90mg/m2
Why do cats required a higher dose of steroids compared to dogs?
Cats have reduced expression of receptors in various organs
How often does glucocorticoid-induced GIT damage occur?
Hardly ever
Which gastroprotectants can be used to prevent steroid incuced GIT damage? (Probably unnecessary)
Sucralfate
H2 antagonists
Omeprazole
Misprostal
Does dose affect ADR of steroids? What can reduce them?
No - once dose is tapered to q48h
What are the possible ADR of steroids and how can they be prevented?
PUPD - restrict water intake esp at night
Polyphagis - restrict food intake
What is the major complication of underdosing glucocorticoids?
Iatrogenic hyperAC
