Naturally occuring Glucocorticoid

Hydrocortisone and cortizone (similar to endogenous)

Active glucocorticoid

prednisone metabolized to active Prednisolone. cortisone metabolized to active hydrocortizone. Conversion occurs in the liver, so in a patient with hepatic impairment, dose the active form

Higher potency steroids, not to be used on highly vascular areas

Do steroids cross the placenta?

Yes and they are distributed into breast milk

If a patient is on steroids for 1 week, do they need to taper?

taper usually not necessary if duration is <2 weeks

In an addison's patient, what kind of steroid would you choose?

water and salt steroid, mineralocorticoid

Common Addison's Dz symptoms

low bp, low glu, hyperpigmentation, vitiligo, electrolyte abnormalities

Treatment of Addison's Dz

2/3 of hydrocortisone (b/c it has mineralcorticoid activity) in the morning, 1/3 in the evening. Duration of action: short 1/2 life, mimics diurnal activity

In an Addisonian Crisis

Give hydrocortisone IV, followed by NS because they are hyponatremic

AE of steroids in kids

growth suppression, cataracts. Avoid long-term use; goal is every other day dosing

Common drug interactions with steroids

NSAIDs, K depleting agents (diuretics), hepatic enzyme inducers (phenobarb, phenytoin)

What kind of dosing do you prescribe for long term use?

Every other dosing. Pick prednisone!!!

Taper should usually not be longer than original duration of therapy

Off-labeled uses of steroids

Fetal organ maturation, antiemetic, bacterial meningitis, BPD in preterm infants, acute spinal cord injury

Which steroid has the most anti-inflammatory potentcy?

Dexamethasone. (hydrocortisone is very low anti-inflammatory)

Which steroid has awful tasting syrup?

Prednisone. Prednisolone syrup tastes better

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CorticoSteroids Phar

Endocrinology

Question	Answer
Endogenous Mineralcorticoid	Aldosterone
Synthetic Mineralcorticoid	Fludrocortisone
Endogenous Corticosteroid	Cortisol
Naturally occuring Glucocorticoid	Hydrocortisone and cortizone (similar to endogenous)
Synthetic Glucocorticoids	Prednisone
Active glucocorticoid	prednisone metabolized to active Prednisolone. cortisone metabolized to active hydrocortizone. Conversion occurs in the liver, so in a patient with hepatic impairment, dose the active form
Fluorinated steroids	Higher potency steroids, not to be used on highly vascular areas
Do steroids cross the placenta?	Yes and they are distributed into breast milk
How does renal failure affect steroid elimination	Not at all
If a patient is on steroids for 1 week, do they need to taper?	taper usually not necessary if duration is <2 weeks
In an addison's patient, what kind of steroid would you choose?	water and salt steroid, mineralocorticoid
Common Addison's Dz symptoms	low bp, low glu, hyperpigmentation, vitiligo, electrolyte abnormalities
Treatment of Addison's Dz	2/3 of hydrocortisone (b/c it has mineralcorticoid activity) in the morning, 1/3 in the evening. Duration of action: short 1/2 life, mimics diurnal activity
How do you monitor treatment of Addison's with hydrocortisone?	BP, glucose, K, Na
In an Addisonian Crisis	Give hydrocortisone IV, followed by NS because they are hyponatremic
Long term suppression can cause permanent	atrophy of gland
Steroids can reduce	Collagen support
AE of steroids in kids	growth suppression, cataracts. Avoid long-term use; goal is every other day dosing
What is considered a high dose of prednisone?	>7.5mg
Cosyntropin test is what kind of test	ACTH stimulation test
Most serious AE of steroid use	Osteoporosis
What medication is recommended for prevention of GC-induced OP?	Bisphosphonates; boniva
Common drug interactions with steroids	NSAIDs, K depleting agents (diuretics), hepatic enzyme inducers (phenobarb, phenytoin)
What kind of dosing may increasing response rate in acute exacerbations of chronic diseases?	Respond better divided doses
What kind of dosing do you prescribe for long term use?	Every other dosing. Pick prednisone!!!
Tapering facts	Taper should usually not be longer than original duration of therapy
Off-labeled uses of steroids	Fetal organ maturation, antiemetic, bacterial meningitis, BPD in preterm infants, acute spinal cord injury
Which steroid has the most anti-inflammatory potentcy?	Dexamethasone. (hydrocortisone is very low anti-inflammatory)
Which steroid has awful tasting syrup?	Prednisone. Prednisolone syrup tastes better

Created by: ltm12

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