A patient who has taken glucocorticoids for 3 years tells a nurse, "I've lost my job. I don't know how I'm going to support my family and pay all the bills." Which glucocorticoid dosage adjust-ment would the nurse expect?
a. Decreased dosage
b. Increased dosage
c. Alternate-day dosing
d. Double the dose
B
At times of physiologic stress, the adrenals secrete large amounts of glucocorticoids and epi-nephrine (which maintain blood pressure and plasma levels of glucose). If glucocorticoid levels are insufficient, hypotension and hypoglycemia occur. The dose should be increased to compen-sate for the increased levels of stress.
Reducing the dosage would put the patient at risk for glucocorticoid insufficiency.
Alternate-day dosing results in decreased dosing, which would put the patient at risk for gluco-corticoid insufficiency.
The dosage needs to be increased, but doubling the dose is too large of an increase.
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