Prescribing Safety Assessment (PSA) Practice Exam

What is an important precaution for patients on long-term steroid treatments who are undergoing surgery?

1. Administer IV steroids at induction

2. Discontinue steroids one week prior

3. Increase oral steroid dose before surgery

4. Provide analgesics during surgery

The correct answer is: Administer IV steroids at induction

Administering intravenous (IV) steroids at induction is an important precaution for patients on long-term steroid treatments undergoing surgery due to the risk of adrenal insufficiency. When patients have been on long-term corticosteroids, their adrenal glands may become suppressed and less able to produce adequate natural cortisol, particularly during periods of physiological stress such as surgery. By administering IV steroids at the time of induction, this precaution helps to ensure that the patients maintain sufficient levels of corticosteroids during the surgical procedure, thus preventing complications associated with adrenal crisis, which can arise from insufficient steroid levels during times of increased stress. This practice aligns with the principles of safe prescribing and perioperative management for patients on chronic steroid therapy, ensuring their physiological needs are met during the surgical process. The other options do not provide the necessary support for patients on long-term steroid therapy in a surgical context. Discontinuing steroids prior to surgery could lead to withdrawal symptoms and increased risk of adrenal insufficiency. Simply increasing the oral steroid dose may not be sufficient or timely to meet the needs of the patient during surgery. Providing analgesics, while generally important for patient comfort, does not specifically address the risk of adrenal insufficiency in this context.