Week 9 Sherpath: Corticosteroid Therapy

Which corticosteroid is the treatment of choice for a patient with Addison disease? A. Betamethasone B. Fludrocortisone C. Prednisone D. Triamcinolone

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

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? _____ mg

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

Which patients does a nurse determine cannot safely receive prednisone? Select all that apply. A. A 33-year-old patient with active tuberculosis B. A 48-year-old patient with hypothyroidism C. A 55-year-old patient with type 2 diabetes D. A 59-year-old patient with dyslipidemia E. A 61-year-old patient with benign prostatic hyperplasia F. A 78-year-old patient with cataracts

A and F A 33-year-old patient with active tuberculosis Patients 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.

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? Select all that apply. A. "I will make sure to have a diet rich in vitamin D and calcium to reduce my risk for osteoporosis." B. "I will make sure to take the prednisone with food to avoid an upset stomach." C. "I may experience side effects and adverse effects such as insomnia, weight gain, and mood swings." D. "If my rheumatoid arthritis symptoms do not improve or get worse, I can take an extra dose of prednisone." E. "If side effects are bothering me, I will stop taking the prednisone and follow up with my physician later."

A, B and C "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.

Which statements regarding the pharmacokinetics of glucocorticoids are accurate? Select all that apply. A. Rate of absorption varies depending on the glucocorticoid and route of administration. B. Rapid absorption occurs when sodium phosphate and sodium succinate esters are given intramuscularly. C. Glucocorticoids are minimally protein bound. D. Glucocorticoids undergo hepatic metabolism to produce inactive metabolites. E. Glucocorticoids undergo biliary excretion.

A, B and D 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.

Which parameters will a nurse ensure have been assessed before administering prednisone to a patient newly diagnosed with systemic lupus erythematous? Select all that apply. A. Weight B. Sodium level C. Glucose level D. Blood pressure E. Liver function tests F. Presence of preexisting edema

A, B, C, D and F 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.

Which parameters would be assessed in a patient who has been prescribed prednisone? Select all that apply. A. Vital signs B. Glucose levels C. Potassium levels D. Testosterone levels E. Presence of preexisting edema F. Skin color, turgor, and temperature

A, B, C, E and F 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 statements accurately describe the actions glucocorticoids exert in the inflammatory process? Select all that apply. A. Stimulation of erythroid cells B. Maintenance of sodium levels in the blood C. Reduction of interleukin-1 release from white blood cells D. Promotion of protein metabolism, glycogen production, and fat redistribution E. Stabilization of lysosomal cell membranes to reduce capillary permeability and leukocyte migration

A, C, D and E Stimulation of erythroid cells Glucocorticoids are able to stimulate the erythroid cells that eventually become red blood cells. Reduction of interleukin-1 release from white blood cells Glucocorticoids 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 migration Glucocorticoids stabilize the cell membranes of lysosomes to reduce capillary permeability and cell migration.

Which patient cannot safely receive therapy with fludrocortisone? A. A 40-year-old patient with pulmonary aspergillosis B. A 52-year-old patient with type 2 diabetes C. A 60-year-old patient with gastroesophageal reflux disease D. A 70-year-old patient with glaucoma

A. 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.

Which statement accurately describes the glucocorticoid that is secreted from the adrenal cortex along with its effect in the body? A. Cortisol, which impacts carbohydrate metabolism B. Aldosterone, which impacts carbohydrate metabolism C. Cortisol, which maintains sodium levels and blood pressure D. Aldosterone, which maintains sodium levels and blood pressure

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

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? A. The prednisone will interact with warfarin, increasing the effects of warfarin. B. The prednisone will interact with warfarin, decreasing the effects of warfarin. C. The prednisone will interact with hydroxychloroquine, increasing the effects of hydroxychloroquine. D. The prednisone will interact with hydroxychloroquine, decreasing the effects of hydroxychloroquine.

A. 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.

Which categories can be used for classifying glucocorticoids? Select all that apply. A. Onset of action B. Duration of action C. Route of administration D. Natural versus synthetic analog E. Potential for sodium and water retention

B, C, D and E Duration of action Duration of action is one way to categorize glucocorticoids. Route of administration Route 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 analog Glucocorticoids may be classified by whether they are natural or synthetic analogs. Potential for sodium and water retention Glucocorticoids may be classified by their potential to retain water and salt.

Which side/adverse effects and/or laboratory results would a nurse monitor for while a patient is receiving fludrocortisone? Select all that apply. A. Symptoms of Cushing syndrome B. Swelling in the extremities C. Increased blood sugars D. Increased potassium levels E. Hypertension F. Decreased bone mineral density

B, C, E and F Swelling in the extremities Edema is an anticipated side effect of fludrocortisone. Increased blood sugars Hyperglycemia may occur in patients receiving fludrocortisone and should be monitored more closely. Hypertension Hypertension may occur with fludrocortisone because it is involved in the regulation of sodium. Decreased bone mineral density Osteoporosis, which is characterized by decreased bone mineral density, is an anticipated adverse effect associated with fludrocortisone.

Which statement about fludrocortisone is accurate? A. Fludrocortisone is a glucocorticoid that is used in the management of inflammatory conditions such as rheumatoid arthritis. B. Fludrocortisone possesses both mineralocorticoid and glucocorticoid activity. C. The anticipated onset of action of fludrocortisone is 1 to 2 hours. D. When given orally, it is minimally protein bound.

B. Fludrocortisone possesses both mineralocorticoid and glucocorticoid activity. Fludrocortisone possesses potent mineralocorticoid activity but also has significant glucocorticoid activity.

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? A. Prednisone will interact with theophylline, causing increased effects of prednisone. B. Prednisone will interact with theophylline, causing decreased effects of prednisone. C. Prednisone will interact with theophylline, causing increased effects of theophylline. D. Prednisone will interact with theophylline, causing decreased effects of theophylline.

B. 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.

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? A. The nurse should administer methylprednisolone because there are no concerns about this drug. B. The nurse should monitor for side effects because methylprednisolone is renally excreted. C. The nurse should monitor for side effects because methylprednisolone undergoes biliary excretion. D. The nurse should call the health care provider because the presence of CKD is a contraindication to treatment with methylprednisolone.

B. 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.

Which statement accurately describes corticosteroids? A. The adrenal medulla secretes corticosteroids. B. There are two types of corticosteroids - epinephrine and norepinephrine. C. Glucocorticoids affect carbohydrate metabolism, and mineralocorticoids regulate electrolytes. D. Corticosteroid levels are regulated by the hypothalamic-pituitary-adrenal axis with use of a positive feedback mechanism.

C. 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? Select all that apply. A. Atenolol B. Atorvastatin C. Enalapril D. HCTZ E. Metformin

D and E 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.