PT6 JAM - exam 1 (steroids, muscle relaxants, NSAIDs)

cortisone

least potent corticosteroid

betamethasone

most potent corticosteroid

GI effects

DDI effects with corticosteroids + NSAIDs

bleeding risk

DDI effects with corticosteroids + anticoagulants

inducers

CYP3A4 ______ decrease corticosteroid concentrations, making them less effective

inhibitors

CYP3A4 ________ increases corticosteroid concentrations, making them more effective

hyperglycemia

precaution of use of corticosteroids in diabetic patients due to risk of __________

live vaccinations

corticosteroids are contraindicated in ___________ and severe systemic infections due to immunusuppression

osteoporosis, fractures, cataracts

long term side effects of corticosteroids

1. adrenal suppression

2. impaired wound healing

3. infection

4. ?

5. ?

6. ?

increased BP, appetite, blood glucose, fluid retention

short term side effects of corticosteroids

1. GI upset

2. restlessness/mood change

3. trouble sleeping

4. ?

5. ?

6. ?

7. ?

25mg

corticosteroid equivalency

cortisone

20mg

corticosteroid equivalency

hydrocortisone

5mg

corticosteroid equivalency

prednisone, prednisolone

4mg

corticosteroid equivalency

methylprednisolone, triamcinolone

0.75mg

corticosteroid equivalency

dexamethasone

0.6mg

corticosteroid equivalency

betamethasone

2mg

patient experiences immunosuppression when using:

> _____ /kg/day prednisone or prednisone equivalent

or

> 20mg/day for > 2 weeks

weakness, confusion, loss of consciousness

adrenal crisis can present as. . .

1. fever

2. hypotension

3. sudden, severe pain

4. sever vomit + diarrhea

5. ?

6. ?

7. ?

lowest

to decrease risk of corticosteroid side effects, use _______ possible for shortest possible time

spasm

sudden, involuntary contraction due to muscle fatigue, dehydration, electrolyte changes

spasticity

increased muscle tone + stiffness, tightness, involuntary jerks due to spinal cord damage

carisoprodol, cyclobenzaprine, metaxalone, methocarbamol

list four antispasmodics (for spasm)

baclofen, dantrolene, gabapentin

list three spasmolytics (for spasticity)

diazepam, tizanidine

list two agents that work for spasm + spasticity

2-4

muscle relaxants should not be used for longer than _______ weeks

dry eyes, urinary retention, dry mouth, constipation

list four anticholinergic effects

lithium toxicity

DDI with NSAIDs + lithium

nephrotoxicity

DDI with NSAIDs + ACEi/diuretics

30

avoid NSAID use if eGFR < ____ mL/min/1.73m2

caution with NSAID use if hyperkalemic (K > 5)

celecoxib

NSAID with contraindication in sulfaonamide allergy

aspirin-sensitive asthma

NSAID contraindication regarding aspirin

CABG

use of NSAIDs is contraindicated prior to or following _______ surgery

third trimester

NSAIDs should be avoided in _______ of pregnancy (unless otherwise directed)

MI, stroke

NSAIDs Black Boxed Warnings:

notable CV risks that may occur early in tx + may increase with duration of use

GI bleed, ulceration, perforation

NSAIDs Black Boxed Warnings:

notable GI risks that can occur at any time

COX 2 inhibitors

______ (otherwise known as selective NSAIDs) have lower risk of GI complications (risk still present)

ketorolac

NSAID with high GI risk, especially if used more than 5 days