Corticosteroids on the NCLEX
Steroid class for NCLEX: indications, CUSHINGOID side effects, taper rule, infection masking.
Corticosteroids show up everywhere, asthma, IBD, autoimmune, anaphylaxis, transplant. The NCLEX tests side effects (CUSHINGOID) and the never-stop-abruptly rule.
Common drugs
Prednisone, methylprednisolone (Solu-Medrol), hydrocortisone, dexamethasone, fluticasone (inhaled), budesonide.
CUSHINGOID side effects
Cataracts, Ulcers, Striae/skin thinning, HTN/hyperglycemia, Infection risk, Necrosis (avascular hip), Glaucoma, Osteoporosis, Immunosuppression, Diabetes.
Taper rule
Never stop abruptly after >2 weeks. Adrenal suppression risk. Taper over weeks to months depending on dose and duration.
Infection masking
Steroids suppress fever and inflammation. Patient may have serious infection with minimal classic signs. Counsel on any sign of infection.
Teaching
Take with food. Don't stop suddenly. Carry medical alert. Monitor blood sugar in diabetics. Bone density screening on chronic therapy.
Frequently asked
Stress dose steroids?
Patients on chronic steroids need extra during surgery/illness, adrenal axis is suppressed.
Inhaled steroids, same risks?
Lower systemic absorption. Rinse mouth after use to prevent thrush.
Quick check
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