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PHARM - Adrenal Disorder/Corticosteroids
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PHARM - Adrenal Disorder/Corticosteroids

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Questions and Answers

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?

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?

  • 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.

    <p>False</p> Signup and view all the answers

    Increase duration and dose of steroids increases the risk of adrenal suppression

    <p>True</p> Signup and view all the answers

    What AE is more common in HIV/AIDS patient taking steroids?

    <p>Pneumocystis jirovecii pneumonia</p> Signup and view all the answers

    The routine use of antacids, PPI’s and H2 antagonists is recommended for ulcer prevention when taking steroids.

    <p>False</p> Signup and view all the answers

    How do you prevent N/V; diarrhea/constipation with steroids?

    <p>Taking with food and water</p> Signup and view all the answers

    What electrolyte abnormality is an AE of steroid use?

    <p>Hypokalemia</p> Signup and view all the answers

    Is this an AE of corticosteroids?

    <p>weight gain, hyperglycemia = YES vertigo; insomnia; depression = YES aseptic necrosis; myalgias; weakness, skin atrophy; ecchymosis = YES Gallbladder disease, Pancreatitis, Decreased appetite, Nasopharyngitis, URI = NO</p> Signup and view all the answers

    Corticosteroids can cause osteoporosis and cataracts when taken for long periods of time.

    <p>True</p> Signup and view all the answers

    Which of the following adverse events are most associated with systemic corticosteroids?

    <p>Insomnia</p> Signup and view all the answers

    What medication can be used as a add on to Hydrocortisone maintenance dose to help with potassium and BP for patients with Addison's?

    <p>fludrocortisone [Florinef] 0.05 - 0.2 mg oral QD</p> Signup and view all the answers

    What can you give to a patient for emergency situations of Adrenal Crisis for Addison's as the patient heads to the hospital?

    <p>Hydrocortisone 100 mg IM</p> Signup and view all the answers

    What is the treatment for Addisonian Crisis?

    <p>100 mg IV bolus, followed by 50 mg HC IV q6h x 24h</p> Signup and view all the answers

    What is the treatment for Secondary and Tertiary Adrenal Insufficiency?

    <p>Hydrocortisone or prednisone as glucocorticoid replacement</p> Signup and view all the answers

    For patients with adrenal insufficiency who are steroid dependent, what would you do for sick days?

    <p>hydrocortisone 30 mg qam and 20 mg qpm</p> Signup and view all the answers

    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?

    <p>Hydrocortisone 50 mg IV q6hrs</p> Signup and view all the answers

    What should you monitor acutely for a patient with Addison's disease in regards corticosteroid regimen

    <p>Blood glucoses</p> Signup and view all the answers

    The treatment of choice for Cushing's is surgical resection.

    <p>True</p> Signup and view all the answers

    If bilateral adrenalectomy is preformed for Cushing disease, what should be considered for ongoing care?

    <p>mineralocorticoid replacement therapy to glucocorticoid replacement</p> Signup and view all the answers

    What is pharmacologic therapy NOT indicated for Cushing's?

    <p>As first line treatment</p> Signup and view all the answers

    What is the first line agent as a pharmaceutical treatment for Cushings if the patient cannot undergo surgery?

    <p>Ketoconazole</p> Signup and view all the answers

    What are contraindications for using Ketoconazole for Cushing's treatment?

    <p>active or chronic liver disease</p> Signup and view all the answers

    What are AE of ketoconazole?

    <p>Gynecomastia, decreased libido, and impotence</p> Signup and view all the answers

    Pharmacologic Treatment of Cushing’s Syndrome

    <p>Can be used as add on therapy to ketoconazole; can be second line to ketoconazole if a patient has liver dz; Increased hirsutism and acne; Must be taken with food; Available through the manufacturer only = Metyrapone Anesthesia induction (IV route only); Used in emergent situations or preoperatively = Etomidate Often used in mild hypercortisolism and for tumor shrinkage = Cabergoline Adrenolytic agent used in adrenal cancer, but rarely used in Cushing'ss = Mitotane</p> Signup and view all the answers

    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?

    <p>Cabergoline</p> Signup and view all the answers

    What adrenal steroidogenesis inhibitors leads to increased androgen production in females (increased hirsutism and acne)?

    <p>Metyrapone</p> Signup and view all the answers

    What is the maintenance therapy for Addison's disease?

    <p>Hydrocortisone 15 mg qAM and 10 mg qPM</p> Signup and view all the answers

    Patients with Addison's can take HC 15mg qAM; 10mg qPM as a treatment. Alternatives are Prednisone _ mg dexamethasone ____ mg nightly

    <p>5, 0.75</p> Signup and view all the answers

    What would you send home with a patient with Addison's disease to use in emergency situations as they travel to the hospital?

    <p>Hydrocortisone 100 mg IM</p> Signup and view all the answers

    The general rule of thumb to avoid adrenal insufficiency is to use less than _____ mg of prednisone equivalent per day.

    <p>7</p> Signup and view all the answers

    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?

    <p>Hydrocortisone or prednisone</p> Signup and view all the answers

    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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    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.

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