Immunology Review Corner

Immunology Review Corner: Chapter 52 (Part 2) of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al.

Prepared by Thao N. Tran, M.D., Puget Sound Allergy, Asthma and Immunology (formerly at Stony Brook University Hospital- SUNY), and Karla Lowe, M.D., Walter Reed Medical Center.


Chapter 52:  Glucocorticoids (part 2)

1. For patients in status asthmaticus, intravenous (IV) methylprednisolone (mPn) is preferred over IV hydrocortisone because:
a. IV mPn has a shorter duration of action
b. IV mPn has less potency, and therefore, less adverse effects
c. IV mPn has less mineralocorticoid activity
d. Methylprednisolone only comes in oral formulations

2. Prednisone metabolism is affected by:
a. Age
b. Gender
c. Ethnicity
d. Race

3. Which of the following concomitantly administered medications reduces the clearance of prednisolone?
a. Phenytoin
b. Phenobarbital
c. Rifampin
d. Ketoconazole

4. A patient previously on a chronic oral glucocorticoid (GC) abruptly stopped all of his medications. He is admitted to the Emergency Department with acute adrenal insufficiency. Which of the following is an appropriate therapeutic step?
a. Half-normal saline, given slowly to maintain hydration
b. IV hydrocortisone 2 mg/kg initially, followed by 1.5 mg/kg every 6 hours until the patient stabilize
c. Oral prednisone 20mg, and then continue his usual oral GC dose
d. IV dexamethasone 10 mg/kg/day until the patient stabilize

5. Which of the following inhaled GCs has a systemic bioavailability that comes almost exclusively from the pulmonary route?
a. Fluticasone propionate
b. Beclomethasone dipropionate
c. Triamcinolone acetonide
d. Flunisolide

6. Which of the following GCs binds to the glucocorticoid receptor with the greatest affinity?
a. Budesonide
b. Flunisolide
c. Triamcinolone acetonide
d. Mometasone furoate

7. Which of the following statements is correct about inhaled GCs?
a. There is a dose-independent reduction in asthma mortality with inhaled GC use.
b. Inhaled GCs are effective in suppressing bronchial hyperresponsiveness, but this effect is not sustained after discontinuation of the GCs.
c. Triamcinolone is considered a second-generation inhaled GCs with proven oral-steroid sparing effect.
d. Beclomethasone suspension is the only inhaled GC approved for nebulization use in children as young as 1 year old.

8. Which of the following inhaled GCs, especially at doses 1000 microgram per day or greater, has the greatest HPA axis suppression?
a. Flunisolide
b. Beclomethasone
c. Fluticasone propionate
d. Budesonide

9. Which of the following statements is correct about nasal GCs?
a. Chronic administration of nasal GCs can significantly block the development of both the immediate and the late-phase allergic responses.
b. Nasal GCs promote production of nasal nitric oxide.
c. Most studies show a clear dose-response curve for nasal GC in the treatment of allergic rhinitis.
d. Nasal GCs are effective in treating perennial allergic rhinitis (AR), but are less effective in those patient s with seasonal AR.

10. Statistically significant suppression of urinary cortisol has been demonstrated with which of the following intranasal GCs?
a. Beclomethasone dipropionate
b. Fluticasone propionate
c. Triamcinolone acetonide
d. Flunisolide

Answers:
1. c, pages 872 & 889
2. a, page 890
3. d, page 890
4. b, page 893
5. a, page 895
6. d, page 895
7. b, pages 896-899
8. c, page 902
9. a, page 903
10. b, page 904