Antiinflammatory and Antigout Drugs Corticosteroid Therapy

Question 6 of 10 A nurse instructs a patient with rheumatoid arthritis who was prescribed prednisone 20 mg PO daily. Which statements by the patient indicate that patient teaching was effective?

"I will make sure to have a diet rich in vitamin D and calcium to reduce my risk for osteoporosis."Patients taking corticosteroids chronically are at increased risk for osteoporosis. Therefore encouraging a diet rich in calcium and vitamin D is important. The patient should also be encouraged to maintain health care provider appointments to monitor bone health, which may necessitate the addition of vitamin D and calcium supplementation or possibly bisphosphonate therapy. "I will make sure to take the prednisone with food to avoid an upset stomach."To avoid gastrointestinal upset, prednisone should be taken with food. "I may experience side effects and adverse effects such as insomnia, weight gain, and mood swings."Side effects and adverse effects associated with prednisone are numerous. Insomnia, weight gain, and mood swings have been commonly reported and should be shared with the patient.

A nurse is caring for a patient who is receiving 4 mg of intravenous methylprednisolone. What equivalent dose of prednisone in milligrams would this patient receive at discharge?

5 Based on equivalent dosing, a nurse recalls that 4 mg of intravenous methylprednisolone is equal in potency to prednisone 5 mg.

Question 4 of 10 Which patients does a nurse determine cannot safely receive prednisone?

A 33-year-old patient with active tuberculosisPatients with an active infection like tuberculosis should not receive glucocorticoids. Given prednisone's effect on the immune system, the body may not be able to clear the infection. A 78-year-old patient with cataracts Patients with cataracts should not receive glucocorticoids because they can worsen the cataracts.

Which patient cannot safely receive therapy with fludrocortisone?

A 40-year-old patient with pulmonary aspergillosis Patients with a systemic fungal infection like pulmonary aspergillosis and those with a hypersensitivity to the drug should not receive fludrocortisone.

Question 1 of 10 Which statement accurately describes the glucocorticoid that is secreted from the adrenal cortex along with its effect in the body?

Cortisol, which impacts carbohydrate metabolism Cortisol is a glucocorticoid that is secreted from the adrenal cortex. It affects carbohydrate, fat, and protein metabolism.

Question 9 of 10 Which categories can be used for classifying glucocorticoids?

Duration of actionDuration of action is one way to categorize glucocorticoids. Route of administrationRoute of administration, such as oral and intranasal, offers one way to classify glucocorticoids, which represent a large and diverse group of steroids. Natural versus synthetic analogGlucocorticoids may be classified by whether they are natural or synthetic analogs. Potential for sodium and water retentionGlucocorticoids may be classified by their potential to retain water and salt.

Which corticosteroid is the treatment of choice for a patient with Addison disease?

Fludrocortisone Fludrocortisone is a mineralocorticoid, which is the treatment of choice in patients requiring mineralocorticoid replacement such as in Addison disease.

Question 3 of 10 Which statement about fludrocortisone is accurate?

Fludrocortisone possesses both mineralocorticoid and glucocorticoid activity.Fludrocortisone possesses potent mineralocorticoid activity but also has significant glucocorticoid activity. The anticipated onset of action of fludrocortisone is 1 to 2 hours.Fludrocortisone's anticipated onset of action is 10 to 20 minutes, peaking in 1.7 hours. When given orally, it is minimally protein bound.When fludrocortisone is given orally as mineralocorticoid replacement, it is extensively protein bound and widely distributed.

Which statement accurately describes corticosteroids?

Glucocorticoids affect carbohydrate metabolism, and mineralocorticoids regulate electrolytes. It is accurate that glucocorticoids affect carbohydrate metabolism and mineralocorticoids are responsible for electrolyte regulation.

Which drugs currently taken by Mrs. Gabriel are anticipated to interact with prednisone?

HCTZ Prednisone may lead to increased side effects of diuretics such as HCTZ. Concomitant administration of prednisone and HCTZ can lead to further depletion of electrolytes like potassium. As a result more side effects, such as constipation, fatigue, and weakness, may occur. Metformin Prednisone may lead to decreased effects of metformin. Therefore Mrs. Crawford should monitor her blood glucose levels more closely. It may not be observed as glucocorticoids increase blood glucose levels; however, careful monitoring of the blood glucose level is warranted.

A patient has been newly prescribed theophylline for asthma management. In addition to theophylline, the patient is also receiving prednisone. Which drug interaction between theophylline and prednisone does a nurse anticipate for this patient?

Prednisone will interact with theophylline, causing decreased effects of prednisone. When prednisone is given with theophylline, the anticipated effect is a reduction in the effects of prednisone. Therefore a higher dosage might be warranted. The patient would need to monitor for worsening of asthmatic symptoms.

Which statements regarding the pharmacokinetics of glucocorticoids are accurate?

Rate of absorption varies depending on the glucocorticoid and route of administration. Glucocorticoid absorption greatly varies depending on both the glucocorticoid of reference and the route in which it is administered. Rapid absorption occurs when sodium phosphate and sodium succinate esters are given intramuscularly. Rapid absorption occurs with two glucocorticoids esters - sodium phosphate and sodium succinate - when given intramuscularly. Glucocorticoids undergo hepatic metabolism to produce inactive metabolites. They undergo hepatic metabolism, forming inactive metabolites.

Question 2 of 10 Which statements accurately describe the actions glucocorticoids exert in the inflammatory process?

Stimulation of erythroid cellsGlucocorticoids are able to stimulate the erythroid cells that eventually become red blood cells. Reduction of interleukin-1 release from white blood cellsGlucocorticoids modulate the inflammatory response by reducing interleukin-1 release from white cells to decrease fever. Promotion of protein metabolism, glycogen production, and fat redistribution they promote protein metabolism, glycogen production, and fat redistribution from peripheral to central areas of the body. Stabilization of lysosomal cell membranes to reduce capillary permeability and leukocyte migrationGlucocorticoids stabilize the cell membranes of lysosomes to reduce capillary permeability and cell migration.

Question 7 of 10 Which side/adverse effects and/or laboratory results would a nurse monitor for while a patient is receiving fludrocortisone?

Swelling in the extremitiesEdema is an anticipated side effect of fludrocortisone. Increased blood sugarsHyperglycemia may occur in patients receiving fludrocortisone and should be monitored more closely. Increased potassium levelsHypokalemia, not hyperkalemia, may occur with fludrocortisone therapy. HypertensionHypertension may occur with fludrocortisone because it is involved in the regulation of sodium. Decreased bone mineral densityOsteoporosis, which is characterized by decreased bone mineral density, is an anticipated adverse effect associated with fludrocortisone.

Question 8 of 10 A nurse is providing care to a patient with chronic kidney disease (CKD) who has been prescribed methylprednisolone. Which statement describes the appropriate nursing action for this patient and the rationale for this action?

The nurse should monitor for side effects because methylprednisolone is renally excreted.This patient can cautiously receive methylprednisolone; however, the patient should be monitored for the emergence of side effects from the glucocorticoid because the drug undergoes renal excretion. The nurse should monitor for side effects because methylprednisolone undergoes biliary excretion.This patient can cautiously receive methylprednisolone; however, the patient should be monitored for the emergence of side effects from the glucocorticoid because the drug undergoes renal, not biliary, excretion. The nurse should call the health care provider because the presence of CKD is a contraindication to treatment with methylprednisolone.Significant renal dysfunction like CKD is not an absolute contraindication to treatment with glucocorticoids. They can be cautiously administered.

Question 5 of 10 A patient has been prescribed prednisone 10 mg PO daily for worsening systemic lupus erythematous (SLE). The patient is also on hydroxychloroquine (for SLE) and warfarin (for venous thromboembolism). Which effect does the nurse anticipate will occur if prednisone is administered to this patient?

The prednisone will interact with warfarin, increasing the effects of warfarin.When prednisone is given with warfarin, it will likely increase the effects of warfarin, increasing the risk for bleeding in this patient. The patient's warfarin will need to be monitored more closely.

Question 10 of 10 Which parameters would be assessed in a patient who has been prescribed prednisone?

Vital signs vital signs are important to assess, particularly blood pressure, because hypertension may occur with glucocorticoid therapy. Glucose levels Glucose levels should be monitored because of a risk for hyperglycemia with prednisone. Potassium levels Potassium levels should be closely followed when receiving prednisone because of a risk for potassium depletion. Presence of preexisting edema Determining whether a patient has preexisting edema before glucocorticoid initiation is critical because prednisone may cause or worsen edema. Skin color, turgor, and temperature Skin color, turgor, and temperature should be assessed because glucocorticoids can cause thinning of the skin.

Which parameters will a nurse ensure have been assessed before administering prednisone to a patient newly diagnosed with systemic lupus erythematous?

Weight Glucocorticoids like prednisone can cause weight gain. Therefore it is important to gain a baseline value for monitoring. Sodium level Sodium level should be monitored because glucocorticoids can alter sodium levels. Glucose level The patient's glucose level should be assessed because glucocorticoids can increase glucose levels. Blood pressure Blood pressure may increase with corticosteroid therapy. Therefore assessing this at baseline is important to determine whether additional interventions should be made to lower the patient's risk for cardiovascular events. Presence of preexisting edema The assessment for preexisting edema is important because prednisone can cause sodium retention.