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