Question 1

A patient is being tapered from long-term therapy with prednisolone and reports weight loss and fatigue.The primary care NP should counsel this patient to:&#10;A) consume foods high in vitamin D and calcium.&#10;B) begin taking dexamethasone because it has longer effects.&#10;C) expect these side effects to occur as the medication is tapered.&#10;D) increase the dose of prednisolone to the most recent amount taken.

Accepted Answer

Sudden discontinuation or rapid tapering of glucocorticoids in patients who have developed adrenal suppression can precipitate symptoms of adrenal insufficiency,including nausea,weakness,depression,anorexia,myalgia,hypotension,and hypoglycemia.When patients experience these symptoms during a drug taper,the dose should be increased to the last dose.Vitamin D deficiency is common while taking glucocorticoids,but these are not symptoms of vitamin D deficiency.Changing to another glucocorticoid is not recommended.Patients should be taught to report the side effects so that action can be taken and should not be told that they are to be expected.

Question 2

A patient will require a long course of steroids to treat a chronic inflammatory condition.The primary care NP expects the specialist to order:&#10;A) prednisone daily.&#10;B) triamcinolone daily.&#10;C) hydrocortisone every other day.&#10;D) dexamethasone every other day.

Accepted Answer

Hydrocortisone is a short-acting glucocorticoid.The use of a short-acting agent and an alternate-day dosage regimen should be considered for long-term therapy.Prednisone and triamcinolone are medium-acting glucocorticoids.Dexamethasone is a long-acting glucocorticoid.

Question 3

A 7-year-old patient who has severe asthma takes oral prednisone daily.At a well-child examination,the primary care NP notes a decrease in the child's linear growth rate.The NP should consult the child's asthma specialist about:

A) gradually tapering the child off the prednisone.
B) a referral for possible growth hormone therapy.
C) giving a double dose of prednisone every other day.
D) dividing the prednisone dose into twice-daily dosing.

Accepted Answer

Administration of a double dose of a glucocorticoid every other morning has been found to cause less suppression of the HPA axis and less growth suppression in children.Because the child has severe asthma,an oral steroid is necessary.Growth hormone therapy is not indicated.Twice-daily dosing would not change the HPA axis suppression.

Question 4

A patient with ulcerative colitis takes 30 mg of methylprednisolone (Medrol)daily.The primary care NP sees this patient for bronchitis and orders azithromycin (Zithromax).The NP should:&#10;A) order intramuscular (IM) methylprednisolone.&#10;B) temporarily decrease the dose of methylprednisolone.&#10;C) change the dosing of methylprednisolone to 15 mg twice a day.&#10;D) stop the methylprednisolone while the patient is taking azithromycin.

Accepted Answer

When given concurrently with macrolide antibiotics,methylprednisolone clearance is reduced,so a smaller dose of methylprednisolone is needed.IM administration does not affect clearance of the drug.Changing the dose to twice-daily dosing is not recommended.Stopping the drug abruptly is not recommended.

Question 5

A 70-year-old patient with COPD who is new to the clinic reports taking 10 mg of prednisone daily for several years.The primary care NP should:&#10;A) tell the patient to take the drug every other day before 9:00 AM.&#10;B) order a serum glucose, potassium level, and bone density testing.&#10;C) perform pulmonary function tests to see if the medication is still needed.&#10;D) begin a gradual taper of the prednisone to wean the patient off the medication.

Accepted Answer

Serum glucose and potassium levels are part of monitoring for side effects of steroids.Because elderly patients are more prone to certain potential catabolic adverse effects of steroid therapy,caution is required.Osteoporosis is often seen with elderly patients,so bone density testing should be performed.The medication dosing regimen should not be changed unless there is an indication of adverse effects.

Question 6

A primary care NP prescribes an oral steroid to a patient and provides teaching about the medication.Which statement by the patient indicates a need for further teaching?&#10;A) &#34;I should take this medication with food.&#34;&#10;B) &#34;I will take the medication at 8:00 AM each day.&#34;&#10;C) &#34;I can expect a decreased appetite while I am taking this medication.&#34;&#10;D) &#34;I should not stop taking the medication without consulting my provider.&#34;

Accepted Answer

Therapeutic administration is least likely to interfere with natural hormone production when the drug is given at the time of natural peak activity.It is generally recommended to administer the full daily dose before 9 AM.Oral glucocorticoids usually are given with meals to limit GI irritation.Common side effects include changes in mood,insomnia,and increased appetite.

Question 7

A patient has been taking oral prednisone 60 mg daily for 3 days for an asthma exacerbation,which has resolved.The patient reports having gastrointestinal (GI)upset.The primary care nurse practitioner (NP)should:

A) discontinue the prednisone.
B) begin tapering the dose of the prednisone.
C) order a proton pump inhibitor (PPI) to counter the effects of the steroid.
D) change the prednisone dosing to every other day.

Accepted Answer

The patient's asthma symptoms have resolved,so the prednisone may be discontinued.If the patient has been on the medication for a few days,it is not necessary to taper the dose before the patient stops taking it.If the patient required long-term dosing of the steroid,a PPI could be used.Every-other-day dosing is used.Alternate-day dosing is sometimes used for long-term therapy to minimize suppression of the hypothalamic-pituitary-adrenal (HPA)axis.

Deck 51: Glucocorticoids