Prednisone

The exam rarely asks what prednisone is — it tests what you monitor and what you teach. The classic stem hands you a patient on chronic steroids who suddenly “ran out” or stopped, then presents hypotension, weakness, hypoglycemia, nausea, and abdominal pain: that is adrenal (Addisonian) crisis, and the priority is an IV hydrocortisone bolus plus IV fluids — not “restart the oral dose.” A second high-yield pattern is the masked infection: steroids blunt the inflammatory response, so fever and WBC become unreliable signs — a serious infection may show only a low-grade temperature — so teach patients to report any sign of illness early.

Classic traps: students give the dose at bedtime, but steroids belong in the morning with food to mimic the natural cortisol peak and ease stomach irritation. Don’t confuse the hyperglycemia steroids cause with insulin’s hypoglycemia — a diabetic on prednisone usually needs more insulin. Mnemonic — the “S” hits: Sugar up, Sodium/fluid up, Skin thins, Sickness signs hidden.