Corticosteroids

Question 1

List the CYP3A4 inducers:

Answer 1

• phenytoin
• rifampin
• barbiturates
• carbamazepine

Question 2

List the CYP3A4 inhibitors:

Answer 2

• protease inhibitors
• antifungals

Question 3

What conditions can corticosteroids be used for?

Answer 3

• arthritis
• asthma
• hepatitis
• lupus
• inflammatory bowel disease
• Crohn’s disease
• Addison’s disease

Question 4

The incidence of side effects for corticosteroids are ________ and __________ related.

Answer 4

• time
• dose

Question 5

Abrupt cessation of prolonged high dose leads to ___________.

Answer 5

adrenal insufficency

Question 6

Goals for CS treatment plan:

Answer 6

• lowest dose
• shortest duration possible

Question 7

Physiologic dose of hydrocortisone:

Answer 7

20 mg dailt

Question 8

physiologic dose of prednisone:

Answer 8

5-7.5 mg qd

Question 9

physiologic dose of dexamethasone:

Answer 9

0.75 mg qd

Question 10

physiologic dose of methylprednisolone:

Answer 10

4 mg qd

Question 11

When is the pituitary less sensitive to steroids?

Answer 11

morning

Question 12

What kind of steroid should be selected for anti-inflammatory purposes?

Answer 12

• steroids with minimal mineralocorticoid activity

Question 13

What dose of cortisone is equivalent to 20 mg hydrocortisone?

Answer 13

25 mg of cortisone

Question 14

What dose of Prednisone is equivalent to 20 mg hydrocortisone?

Answer 14

5 mg of prednisone

Question 15

What dose of methylprednisolone is equivalent to 20 mg of hydrocortisone?

Answer 15

4 mg methylprednisolone

Question 16

What dose of dexamethasone is equivalent to 20 mg of hydrocortisone?

Answer 16

0.75 mg dexamethasone

Question 17

Patients on high dose glucocorticoids SHOULD NOT receive ___________.

Answer 17

live vaccine

Question 18

Clinical presentation of Cushing’s:

Answer 18

• obesity
• moon face
• buffalo hump + supraclavicular fat accumulation
• muscle weakness (myopathy)
• easy bruising

Question 19

Standards for when to taper:

Answer 19

• receive GC dose equivalent to prednisone >7.5 mg/day for more than 3 weeks
• receive evening dose of prednisone > 5mg for more than a few weeks
• patients with Cushingoid appearance

Question 20

When do you stop tapering?

Answer 20

When the physiologic dose is reached

Question 21

Recommendation for stable taper:

Answer 21

• 10-20% of total daily dose

Question 22

How long can it take the HPA axis to recover after steroid discontinuation?

Answer 22

1 year