Podcast
Questions and Answers
What is the different between my steroid options?
What is the different between my steroid options?
↑NA+ = ↑H2O = ↑volume = Mineralcorticoid endogenous = aldosterone = Mineralcorticoid Regulation of fat, carbohydrate and protein metabolism = Glucocorticoid endogenous = cortisol = Glucocorticoid
How long does the glucocorticoid last?
How long does the glucocorticoid last?
cortisone = Short acting [Duration 8-12 hrs] hydrocortisone = Short acting [Duration 8-12 hrs] prednisolone/prednisone = Intermediate acting [Duration 18-36 hrs] methylprednisolone = Intermediate acting [Duration 18-36 hrs]
What is the general rules of using steroids?
What is the general rules of using steroids?
- Taper is always needed
- Taper is needed is using greater than 2 weeks (correct)
- Always use the LONGEST course of steroid
- Tapering is never needed
Prednisone is equivalent between all PO and IV forms.
Prednisone is equivalent between all PO and IV forms.
Increase duration and dose of steroids increases the risk of adrenal suppression
Increase duration and dose of steroids increases the risk of adrenal suppression
What AE is more common in HIV/AIDS patient taking steroids?
What AE is more common in HIV/AIDS patient taking steroids?
The routine use of antacids, PPI’s and H2 antagonists is recommended for ulcer prevention when taking steroids.
The routine use of antacids, PPI’s and H2 antagonists is recommended for ulcer prevention when taking steroids.
How do you prevent N/V; diarrhea/constipation with steroids?
How do you prevent N/V; diarrhea/constipation with steroids?
What electrolyte abnormality is an AE of steroid use?
What electrolyte abnormality is an AE of steroid use?
Is this an AE of corticosteroids?
Is this an AE of corticosteroids?
Corticosteroids can cause osteoporosis and cataracts when taken for long periods of time.
Corticosteroids can cause osteoporosis and cataracts when taken for long periods of time.
Which of the following adverse events are most associated with systemic corticosteroids?
Which of the following adverse events are most associated with systemic corticosteroids?
What medication can be used as a add on to Hydrocortisone maintenance dose to help with potassium and BP for patients with Addison's?
What medication can be used as a add on to Hydrocortisone maintenance dose to help with potassium and BP for patients with Addison's?
What can you give to a patient for emergency situations of Adrenal Crisis for Addison's as the patient heads to the hospital?
What can you give to a patient for emergency situations of Adrenal Crisis for Addison's as the patient heads to the hospital?
What is the treatment for Addisonian Crisis?
What is the treatment for Addisonian Crisis?
What is the treatment for Secondary and Tertiary Adrenal Insufficiency?
What is the treatment for Secondary and Tertiary Adrenal Insufficiency?
For patients with adrenal insufficiency who are steroid dependent, what would you do for sick days?
For patients with adrenal insufficiency who are steroid dependent, what would you do for sick days?
MR is admitted to the hospital for adrenal crisis. She has a previous diagnosis of Addison’s Disease, but stopped taking her meds because she ran out and could not afford her refills. In addition to fluids, what corticosteroid regimen would you start on MR?
MR is admitted to the hospital for adrenal crisis. She has a previous diagnosis of Addison’s Disease, but stopped taking her meds because she ran out and could not afford her refills. In addition to fluids, what corticosteroid regimen would you start on MR?
What should you monitor acutely for a patient with Addison's disease in regards corticosteroid regimen
What should you monitor acutely for a patient with Addison's disease in regards corticosteroid regimen
The treatment of choice for Cushing's is surgical resection.
The treatment of choice for Cushing's is surgical resection.
If bilateral adrenalectomy is preformed for Cushing disease, what should be considered for ongoing care?
If bilateral adrenalectomy is preformed for Cushing disease, what should be considered for ongoing care?
What is pharmacologic therapy NOT indicated for Cushing's?
What is pharmacologic therapy NOT indicated for Cushing's?
What is the first line agent as a pharmaceutical treatment for Cushings if the patient cannot undergo surgery?
What is the first line agent as a pharmaceutical treatment for Cushings if the patient cannot undergo surgery?
What are contraindications for using Ketoconazole for Cushing's treatment?
What are contraindications for using Ketoconazole for Cushing's treatment?
What are AE of ketoconazole?
What are AE of ketoconazole?
Pharmacologic Treatment of Cushing’s
Syndrome
Pharmacologic Treatment of Cushing’s Syndrome
What alternative pharmaceutical treatment for Cushing's can lead to impulse-control disorders and must be avoided in patients with Bipolar Disorder or Impulse-Control Disorders?
What alternative pharmaceutical treatment for Cushing's can lead to impulse-control disorders and must be avoided in patients with Bipolar Disorder or Impulse-Control Disorders?
What adrenal steroidogenesis inhibitors leads to increased androgen production in females (increased hirsutism and acne)?
What adrenal steroidogenesis inhibitors leads to increased androgen production in females (increased hirsutism and acne)?
What is the maintenance therapy for Addison's disease?
What is the maintenance therapy for Addison's disease?
Patients with Addison's can take HC 15mg qAM; 10mg qPM as a treatment. Alternatives are Prednisone _ mg dexamethasone ____ mg nightly
Patients with Addison's can take HC 15mg qAM; 10mg qPM as a treatment. Alternatives are Prednisone _ mg dexamethasone ____ mg nightly
What would you send home with a patient with Addison's disease to use in emergency situations as they travel to the hospital?
What would you send home with a patient with Addison's disease to use in emergency situations as they travel to the hospital?
The general rule of thumb to avoid adrenal insufficiency is to use less than _____ mg of prednisone equivalent per day.
The general rule of thumb to avoid adrenal insufficiency is to use less than _____ mg of prednisone equivalent per day.
A patient presents with signs of adrenal insufficiency, but without any hyperkalemia. The patient has weakness, arthralgias, hypoglycemia with low blood pressure and sodium levels. What is the best treatment?
A patient presents with signs of adrenal insufficiency, but without any hyperkalemia. The patient has weakness, arthralgias, hypoglycemia with low blood pressure and sodium levels. What is the best treatment?
Study Notes
Steroid Options and General Rules
- There is no difference between PO and IV forms of prednisone
- Increasing duration and dose of steroids increases the risk of adrenal suppression
- Routine use of antacids, PPI's, and H2 antagonists is recommended for ulcer prevention when taking steroids
- Glucocorticoids can last for an unspecified amount of time
Adverse Effects (AE) and Contraindications
- More common AE in HIV/AIDS patients taking steroids: opportunistic infections
- AE of steroid use: nausea/vomiting, diarrhea/constipation, electrolyte abnormalities (e.g., hypokalemia), osteoporosis, cataracts
- Ketoconazole AE: includes nausea, vomiting, abdominal pain, headache, and dizziness
- Contraindications for ketoconazole: liver disease, adrenal insufficiency, and concurrent use of certain medications
Addison's Disease and Adrenal Insufficiency
- Treatment for Addisonian Crisis: fluids, corticosteroids, and electrolyte replacement
- Treatment for Secondary and Tertiary Adrenal Insufficiency: depends on the underlying cause
- For patients with adrenal insufficiency who are steroid-dependent, increase steroid dose on sick days
- Maintenance therapy for Addison's disease: hydrocortisone 15mg qAM, 10mg qPM or prednisone/dexamethasone alternatives
- Send home with patients: emergency dosage of hydrocortisone to use in emergency situations
Cushing's Syndrome
- Treatment of choice: surgical resection
- If bilateral adrenalectomy is performed, consider lifelong glucocorticoid replacement therapy
- Pharmacologic therapy not indicated for Cushing's: ketoconazole
- First-line agent for pharmaceutical treatment: ketoconazole
- Alternative pharmaceutical treatment: can lead to impulse-control disorders and must be avoided in patients with Bipolar Disorder or Impulse-Control Disorders
- Adrenal steroidogenesis inhibitors: leads to increased androgen production in females (increased hirsutism and acne)
General Rules and Treatment
- General rule of thumb to avoid adrenal insufficiency: use less than a certain amount of prednisone equivalent per day
- Treatment for patients presenting with adrenal insufficiency symptoms: hydrocortisone and fluid replacement
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Description
This quiz will help you differentiate between various types of steroids and their uses. Learn about the differences in effects, dosages, and potential side effects.
