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Please consult the latest official manual style if you have any questions regarding the format accuracy. Maintenance treatment of asthma as prophylactic therapy. May decrease requirement for or eliminate use of systemic corticosteroids in patients with asthma. Potent, locally acting anti-inflammatory and immune modifier.
Therapeutic Effects: Decreases frequency and severity of asthma attacks. Improves asthma symptoms. CNS: headache. EENT: cataracts, dysphonia, oropharyngeal fungal infections, pharyngitis, rhinitis, sinusitis. Resp: bronchospasm, cough, wheezing. Endo: adrenal suppression increased dose, long-term therapy onlydecreased growth children.
MS: back pain. Assess pulmonary function periodically by measuring lung volumes, breath sounds, respiratory rate, and other symptoms wheezing, dyspnea, shortness of breath See Appendices IJ, K. Report changes in pulmonary function to help document the effects of drug therapy in treating asthma.
Observe for paradoxical bronchospasm cough, wheezing, dyspneaespecially at higher or excessive doses. If condition occurs, advise patient to withhold medication and notify physician immediately. Assess muscle strength periodically during long-term use. Although inhalation reduces the risk of systemic musculoskeletal damage, some degree of weakness and bone loss may still occur during prolonged, extensive use.
Assess any back pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems. Report signs of adrenal suppression, including hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, and restlessness. Assess growth rate in children receiving chronic therapy; report delayed or stunted growth to the physician.
Implement resistive exercises and weight-bearing activities to minimize muscle wasting and osteoporosis. Use caution to prevent musculoskeletal damage in patients with preexisting muscle and bone loss. Design and implement appropriate aerobic exercise and respiratory muscle—training programs to maintain optimal cardiovascular and pulmonary function. Counsel patient on proper use of metered-dose inhaler; observe use of this device whenever possible to ensure proper technique.
Advise patient to not exceed the recommended dose or frequency of inhalations. Contact physician immediately if bronchospasm is not relieved by medication or is accompanied by severe headache or other symptoms. Caution patient not to use this drug to treat acute symptoms. A rapid-acting inhaled beta-adrenergic bronchodilator is typically used for relief of acute asthma attacks. Instruct patient to report any loss of vision that might indicate cataracts or increased intraocular pressure.
Advise patient that corticosteroids cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. This div only appears when the trigger link is hovered over. Otherwise it is hidden from view. AccessBiomedical Science. AccessEmergency Medicine.
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Report changes in pulmonary function to help document the effects of drug therapy in treating asthma. Observe for paradoxical bronchospasm cough, wheezing, dyspnea , especially at higher or excessive doses. If condition occurs, advise patient to withhold medication and notify physician immediately. Assess muscle strength periodically during long-term use. Although inhalation reduces the risk of systemic musculoskeletal damage, some degree of weakness and bone loss may still occur during prolonged, extensive use.
Assess any back pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems. Report signs of adrenal suppression, including hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, and restlessness.
Assess growth rate in children receiving chronic therapy; report delayed or stunted growth to the physician. Implement resistive exercises and weight-bearing activities to minimize muscle wasting and osteoporosis. Use caution to prevent musculoskeletal damage in patients with preexisting muscle and bone loss. Design and implement appropriate aerobic exercise and respiratory muscle—training programs to maintain optimal cardiovascular and pulmonary function.
Counsel patient on proper use of metered-dose inhaler; observe use of this device whenever possible to ensure proper technique. Advise patient to not exceed the recommended dose or frequency of inhalations. Contact physician immediately if bronchospasm is not relieved by medication or is accompanied by severe headache or other symptoms.
Caution patient not to use this drug to treat acute symptoms. A rapid-acting inhaled beta-adrenergic bronchodilator is typically used for relief of acute asthma attacks. Instruct patient to report any loss of vision that might indicate cataracts or increased intraocular pressure. Advise patient that corticosteroids cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'.
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Contact us. What is accessible design? Consumer accessibility information. Ease of Use Certified products. Easy to Open Certified packaging. Improving packaging for you. Packaging Feedback Form. Therapeutic effects of steroids can often parallel undesirable side effects, especially when high doses and long-term therapy are required.
By anticipating the potential side effects and implementing preventive measures where possible Table 2 , 1 — 4 patients can obtain maximum benefits with minimum adverse effects. The dosage range for steroids is wide, and patient response is variable. A low or maintenance dosage is approximately 0. Short-term, low-dose steroid therapy rarely results in any of the adverse effects listed in Table 2.
In long-term therapy, alternate-day administration should be considered. Some disease states, however, such as temporal arteritis and systemic lupus erythematosus, may not be adequately controlled with alternate-day therapy. Doubling the dosage and administering the drug every other day in the morning more closely mimics the endogenous corticosteroid circadian rhythm. This form of administration enables the patient to experience the therapeutic effects while side effects are minimized.
Viral croup is a common childhood disease. In fact, it is the most common form of upper airway obstruction in children six months to six years of age. Corticosteroids have been studied in the management of croup for the past 30 years, but their use in this condition is controversial. The use of steroids in children with croup is associated with significant clinical improvement at about 12 hours post-treatment and results in less endotracheal intubation.
Most current research focuses on outpatient use of corticosteroids in the treatment of moderate and severe croup.
Some authors have found that routine use of steroids reduces the need for hospitalization. Although budenoside is well tolerated with minimal side effects because of limited systemic availability, it is not yet available for use in the United States except in a nasal form. A single intramuscular injection of 0. Therefore, intramuscular corticosteroid treatment should be considered in patients with moderate croup before discharge from the emergency department when outpatient therapy is entertained.
Pneumocystis carinii pneumonia PCP is a leading cause of morbidity and mortality in patients infected with human immunodeficiency virus HIV. This clinically significant complication of HIV infection occurs in 60 to 80 percent of patients with acquired immunodeficiency syndrome not receiving prophylaxis 14 and causes death in approximately 25 percent of its victims. Since the late s, adjunctive treatment with corticosteroids has been documented in case reports and research studies with favorable clinical results, and it is currently endorsed by the National Institutes of Health as a standard therapy.
Documented benefits of corticosteroid therapy in patients with PCP include reduced morbidity and mortality, decreased need for mechanical ventilation assistance and a reduced long-term decline in pulmonary function or exercise tolerance. Progression of other opportunistic infections associated with HIV infection as a result of the immunosuppressive effects of corticosteroids is a risk that must be considered.
While some studies report only minor complications associated with steroid therapy, such as reactivation of localized herpetic lesions, 18 others have reported an increased incidence of infection and cancer. Based on the benefits and risks of adjunctive corticosteroid therapy, the current recommendations are not intended for all patients but only for those with confirmed or suspected HIV and PCP infection who are at high risk of respiratory failure and death. Patients at risk include those with an arterial oxygen pressure of less than 70 mm Hg or an arterial-alveolar gradient of more than 35 mm Hg.
The recommended dosing regimen is oral prednisone, 40 mg twice daily for five days, then 40 mg once daily for five days, then 20 mg daily for the duration of the anti-pneumocystis therapy. Methylprednisolone, given at 75 percent of the oral prednisone dosage, can be substituted if parenteral therapy is necessary. A confirmatory diagnosis of PCP and HIV infection should be obtained, and other diseases, such as tuberculosis and cryptococcosis, should be ruled out before steroid therapy is begun.
Further investigation is required to determine the appropriate use and benefits of steroid therapy when the patient has concomitant life-threatening infections and when the patient has already received more than three days of anti-pneumocystis therapy and has developed significant hypoxia. Hyperthyroidism is a common disease affecting around 2 percent of women and 0. The amount of benefit and the effect on patient outcome in this circumstance is not yet known. Graves' eye disease is treated by first normalizing the thyroid function and then administering diuretics and systemic glucocorticoids.
Other causes of hyperthyroidism that may be treated with corticosteroids are subacute thyroiditis and thyroid storm. Hyperthyroid disease related to thyroiditis is usually mild and self-limited. Beta blockers may be used to treat symptoms. In subacute thyroiditis, non-steroidal anti-inflammatory drugs or corticosteroids can be used to relieve thyroid pain and tenderness.
Thyroid storm is a life-threatening condition of the hyperthyroid state. Corticosteroids are used as adjuvant analgesics for pain in cancer patients and patients with neuropathic pain such as herpes zoster—related neuropathy, spinal cord compression and pain following oral surgery.
Prednisone, at a dosage of 7. Patients with nerve compression pain or pain resulting from increased intracranial pressure showed a better response when compared with patients with other pain syndromes.
Glucocorticoids also known as corticosteroids are hormones that are produced naturally in the body. They are necessary for normal working of the body. They have a strong anti-inflammatory effect and reduce the swelling and pain in joints and other organs. They do not cure the disease. They should not be confused with male or female steroid hormones, which are known for their misuse among athletes. Prednisolone is the most common type of glucocorticoid prescribed. Although prednisone is slightly different, the information contained in this document also applies to that medication.
Prednisolone works very quickly. Prednisolone can be swallowed as tablets or liquid. It is usually taken once or twice a day. Sometimes it is taken every second day.
It is usually taken in the morning, with or immediately after food. Other glucocorticoids can be given by injection into joints, soft tissues or muscles. An injection into a vein intravenous may also be given if required.
There are a variety of strengths of corticosteroids available and can be adjusted to suit your needs without you having to take large numbers of tablets. It is important to check the strength of the tablets as they look very similar. The dose depends on the severity of the disease. A high dose may be used initially and then reduced by your doctor as symptoms improve. To minimise the risk of side effects the smallest dose possible will be used. Sometimes your doctor may increase the dose temporarily when your body is under stress, for example during a surgical procedure or if you have a severe illness such as an infection.
Prednisolone and other glucocorticoids should be taken with caution with nonsteroidal anti-inflammatory drugs NSAIDs as the risk of side effects such as stomach ulcer is increased. Low dose prednisolone, taken for a few days or even a few weeks, does not normally cause any unwanted side effects.
If prednisolone is taken in high doses or for a long time certain predictable side effects can occur. Some of these improve after prednisolone is stopped. Many can be minimised by giving the lowest effective dose over the shortest possible period of time.
The effects may also be minimised by giving the medicine by injection into the joints or into a muscle. This information has been produced by the Australian Rheumatology Association ARA to help you understand the medicine that has been prescribed for you. Please read it carefully and discuss it with your doctor. The information in this sheet has been obtained from various sources and has been reviewed by the ARA.
It is intended as an educational aid and does not cover all possible uses, actions, precautions, side effects, or interactions of the medicines mentioned. This information is not intended as medical advice for individual problems nor for making an individual assessment of the risks and benefits of taking a particular medicine.
It can be reproduced in its entirety but cannot be altered without permission from the ARA. The NHMRC publication: How to present the evidence for consumers: preparation of consumer publications was used as a guide in developing this publication.
Arthritis Australia funds research and advocates to improve care, management, support and quality-of-life for people with arthritis. Arthritis Australia advocates to government, business, industry and community leaders to improve care, management, support and quality of life for people with arthritis. What benefit can you expect from your treatment?
What is the dosage? Can other medicines be taken with prednisolone? Prednisolone may be used with other arthritis medicines including: other disease modifying anti-rheumatic drugs DMARDs such as methotrexate anti-inflammatory medicines NSAIDs such as naproxen Naprosyn or ibuprofen Brufen, Nurofen with caution simple pain relieving medicines such as paracetamol.
There are separate information sheets for the medicines mentioned above. Are there any side effects? Most common possible side effects Weight gain : The most common side effects are rounding of the face and weight gain around the stomach.
These are due to altered metabolism, increased appetite and salt retention. Your doctor will tell you if you need a bone density BMD test to check your risk of osteoporosis.
Skin: The skin, especially on the arms and legs, can become thin, easily bruised and slow to heal. This occurs particularly after long term use, on higher doses and in older people with skin problems related to aging.
In younger people, acne may be a problem. Diabetes: Prednisolone can cause the onset of diabetic symptoms or cause a rise in blood sugar in people with diabetes. This may require a change in their diabetes medicine.
You should consult your general practitioner if you experience an increase in blood sugar levels. Prednisolone can also cause the onset of diabetic symptoms in people who are at risk of diabetes. Blood pressure: Prednisolone may cause an increase in blood pressure or make it more difficult to control. This can be monitored and changes can be made to your blood pressure medicine if required.
Cholesterol: Prednisolone can cause a rise in blood cholesterol. This can be monitored and changes can be made to your treatment if required. Psychological effects: Prednisolone can cause a feeling of excitement, mood swings or personality changes such as irritability, agitation or depression.
While some psychological effects are quite common, they rarely cause significant problems. Sleep may also be affected but can be minimised by taking corticosteroids in the morning. Infections: There may be an increased risk of some infections, including mouth infections such as oral thrushshingles and lung infections. Pre-existing infections such as tuberculosis TB may become active again. It is important to tell your doctor if you have a chronic infection or if you have been exposed to TB earlier in your life.
Indigestion or heartburn can occur. Taking prednisolone with food can reduce this. Ulcers: If taken with nonsteroidal anti-inflammatory medicines NSAIDsit can further increase the risk of stomach or duodenal ulcers. Your doctor will advise you about how to reduce this risk.
Less common or rare possible side effects Eyes: With long-term high-dose treatment prednisolone may increase development of cataracts. Other: Facial flushes, constipation and avascular necrosis a painful bone condition usually seen in the hip or knee can occur very rarely. What precautions are necessary? Tests Blood sugar and cholesterol levels can be increased by prednisolone, so you will need to have blood tests to check these levels.
Your doctor will tell you when the blood tests are required. Your general practitioner will be told about the tests you need to have. It is important to see your general practitioner if you have been asked to do so as they have an important role to play in monitoring your condition.
Use in pregnancy and breastfeeding Prednisolone may be used safely in pregnancy and breastfeeding. It is important to tell your doctor if you are, or intend to become pregnant or if you are breastfeeding. Use with other medicines Corticosteroids can interact with other medicines. You should tell all your doctors about all medicines you are taking or plan to take. You should also mention your treatment when you see other health professionals, even if you have stopped taking corticosteroids within the last 12 months.
Talk with your rheumatologist before receiving any vaccines. Your doctor may tell you that you need some additional prednisolone at the time of surgery. Your adrenal glands, which are just above the kidneys, normally make glucocorticoids in small amounts. These are important for many normal body functions. If prescribed glucocorticoids are taken, the body begins to make less than usual or even stops making glucocorticoids completely.
This problem is called adrenal insufficiency. Signs of adrenal insufficiency include weakness, fatigue, fever, weight loss, vomiting, diarrhoea and abdominal pain. If you experience any of these problems, seek medical help. How to store prednisolone Store prednisolone tablets at room temperature, away from heat, moisture and light e. Keep all medicines out of reach of children. Important things to remember You must see your rheumatologist regularly to make sure the treatment is working and check for possible side effects.
You should have regular blood tests as suggested by your rheumatologist. Do not increase or reduce the dose of prednisolone or prednisone unless your doctor or rheumatologist tells you to. It is important to tell your rheumatologist if you have a new serious illness such as a serious infection, cancer or heart failure. If you are worried about any side effects, you should contact your rheumatologist as soon as possible. If you plan to become pregnant, you must discuss the timing with your rheumatologist.
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Side/Adverse Effects. Interventions. Patient Instructions. • Suppression of adrenal function • Recommend larger dosage during times of illness and stress. Cortisone and cortisol are short-acting with a biological half-life of under 12 hours and are not frequently used. Prednisone, prednisolone. They should not be confused with male or female steroid hormones, which are known for their misuse among athletes. Prednisolone is the most common type of. Advise patient that corticosteroids cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious. Prednisone (Deltasone) is a steroid. Adverse reactions: Increased chance of infection, blood sugars increase, and long term they are at risk for osteoporosis. Pneumocystis carinii pneumonia PCP is a leading cause of morbidity and mortality in patients infected with human immunodeficiency virus HIV. Remember me. Autosuggest Results. It can be reproduced in its entirety but cannot be altered without permission from the ARA.Corticosteroids were first used in clinical practice in for the treatment of rheumatoid arthritis. Indications since then have spanned multiple specialties and organ systems, including dermatology, rheumatology, immunology and oncology.
This review covers practical uses of steroids as well as current and frequently overlooked clinical applications that may be helpful to family physicians.
If physicians understand the composition and physiologic effects of corticosteroid agents, appropriate drug selection can be made and inappropriate or problematic uses can be avoided. Corticosteroid agents mimic the endogenous steroid hormones produced in the adrenal cortex—mineralocorticoid aldosterone and glucocorticoid cortisol.
Mineralocorticoids are primarily regulated by the renin-angiotensin system and possess salt-retaining properties. Glucocorticoids are primarily regulated by corticotropin ACTH and can have anti-inflammatory effects, as well as several metabolic and immunogenic effects, on the body.
While several corticosteroid agents possess properties of both hormones, fludrocortisone is most commonly used for its mineralocorticoid activity and hydrocortisone, cortisone, prednisone and prednisolone are used for their glucocorticoid effects. Table 1 summarizes the relative potencies of the hormonal effects in addition to providing equivalent doses. Therapeutic effects of steroids can often parallel undesirable side effects, especially when high doses and long-term therapy are required.
By anticipating the potential side effects and implementing preventive measures where possible Table 2 , 1 — 4 patients can obtain maximum benefits with minimum adverse effects. The dosage range for steroids is wide, and patient response is variable. A low or maintenance dosage is approximately 0. Short-term, low-dose steroid therapy rarely results in any of the adverse effects listed in Table 2. In long-term therapy, alternate-day administration should be considered.
Some disease states, however, such as temporal arteritis and systemic lupus erythematosus, may not be adequately controlled with alternate-day therapy. Doubling the dosage and administering the drug every other day in the morning more closely mimics the endogenous corticosteroid circadian rhythm. This form of administration enables the patient to experience the therapeutic effects while side effects are minimized.
Viral croup is a common childhood disease. In fact, it is the most common form of upper airway obstruction in children six months to six years of age. Corticosteroids have been studied in the management of croup for the past 30 years, but their use in this condition is controversial.
The use of steroids in children with croup is associated with significant clinical improvement at about 12 hours post-treatment and results in less endotracheal intubation. Most current research focuses on outpatient use of corticosteroids in the treatment of moderate and severe croup. Some authors have found that routine use of steroids reduces the need for hospitalization. Although budenoside is well tolerated with minimal side effects because of limited systemic availability, it is not yet available for use in the United States except in a nasal form.
A single intramuscular injection of 0. Therefore, intramuscular corticosteroid treatment should be considered in patients with moderate croup before discharge from the emergency department when outpatient therapy is entertained.
Pneumocystis carinii pneumonia PCP is a leading cause of morbidity and mortality in patients infected with human immunodeficiency virus HIV. This clinically significant complication of HIV infection occurs in 60 to 80 percent of patients with acquired immunodeficiency syndrome not receiving prophylaxis 14 and causes death in approximately 25 percent of its victims.
Since the late s, adjunctive treatment with corticosteroids has been documented in case reports and research studies with favorable clinical results, and it is currently endorsed by the National Institutes of Health as a standard therapy. Documented benefits of corticosteroid therapy in patients with PCP include reduced morbidity and mortality, decreased need for mechanical ventilation assistance and a reduced long-term decline in pulmonary function or exercise tolerance.
Progression of other opportunistic infections associated with HIV infection as a result of the immunosuppressive effects of corticosteroids is a risk that must be considered. While some studies report only minor complications associated with steroid therapy, such as reactivation of localized herpetic lesions, 18 others have reported an increased incidence of infection and cancer. Based on the benefits and risks of adjunctive corticosteroid therapy, the current recommendations are not intended for all patients but only for those with confirmed or suspected HIV and PCP infection who are at high risk of respiratory failure and death.
Patients at risk include those with an arterial oxygen pressure of less than 70 mm Hg or an arterial-alveolar gradient of more than 35 mm Hg. The recommended dosing regimen is oral prednisone, 40 mg twice daily for five days, then 40 mg once daily for five days, then 20 mg daily for the duration of the anti-pneumocystis therapy.
Methylprednisolone, given at 75 percent of the oral prednisone dosage, can be substituted if parenteral therapy is necessary.
A confirmatory diagnosis of PCP and HIV infection should be obtained, and other diseases, such as tuberculosis and cryptococcosis, should be ruled out before steroid therapy is begun.
Further investigation is required to determine the appropriate use and benefits of steroid therapy when the patient has concomitant life-threatening infections and when the patient has already received more than three days of anti-pneumocystis therapy and has developed significant hypoxia.
Hyperthyroidism is a common disease affecting around 2 percent of women and 0. The amount of benefit and the effect on patient outcome in this circumstance is not yet known. Graves' eye disease is treated by first normalizing the thyroid function and then administering diuretics and systemic glucocorticoids.
Other causes of hyperthyroidism that may be treated with corticosteroids are subacute thyroiditis and thyroid storm. Hyperthyroid disease related to thyroiditis is usually mild and self-limited. Beta blockers may be used to treat symptoms.
In subacute thyroiditis, non-steroidal anti-inflammatory drugs or corticosteroids can be used to relieve thyroid pain and tenderness. Thyroid storm is a life-threatening condition of the hyperthyroid state. Corticosteroids are used as adjuvant analgesics for pain in cancer patients and patients with neuropathic pain such as herpes zoster—related neuropathy, spinal cord compression and pain following oral surgery.
Prednisone, at a dosage of 7. Patients with nerve compression pain or pain resulting from increased intracranial pressure showed a better response when compared with patients with other pain syndromes. Perioperative use of corticosteroids has been advocated to reduce pain and decrease edema and trismus following oral surgical procedures. The most significant improvement occurs in the treatment of postoperative edema. Dosages of prednisone between 40 and 80 mg per day can be used.
Maximal benefit has been achieved after third-molar extraction, although some benefit has been reported after other surgeries. Some evidence indicates that combining corticosteroids with acyclovir Zovirax will decrease the duration of zoster-associated pain. Systemic treatment with corticosteroids such as prednisone, at 40 mg per day for three weeks, decreases the proportion of patients affected by postherpetic neuralgia, especially pain occurring six to 12 weeks after onset.
Alcoholic hepatitis is a chronic, progressive and often fatal disease. Treatment has generally been supportive. Meta-analysis of studies from to supports the finding that patients with acute severe alcoholic hepatitis and hepatic encephalopathy, without gastrointestinal bleeding, benefit from a trial of corticosteroid therapy.
Further clinical trials were recommended to clarify the role of steroids in the treatment of alcoholic hepatitis. Bacterial meningitis is a serious disease that may result in death or permanent neurologic complications such as seizures, paralysis or sensorineural hearing loss.
These produce inflammatory components such as cytokines, which lead to meningeal inflammation and increased intracranial pressure. Studies show that potent corticosteroids, such as dexamethasone, combined with appropriate antibiotics reduce the risk of acquired sensorineural deafness and the incidence of other neurologic sequelae in meningitis caused by Haemophilus influenzae.
The drug was administered in a dosage of 0. Corticosteroids may also be used in the treatment of tuberculous meningitis. In one randomized, controlled study 55 involving 47 patients in India, dexamethasone was found to be useful as an adjunct treatment in cases of tuberculous meningitis, especially in patients with severe disease. A more recent randomized trial 56 using prednisone in children with tuberculous meningitis showed that prednisone in a dosage of 2 to 4 mg per kg per day for one month improved survival rate and intellectual outcome.
Table 4 57 lists other unlabeled uses of corticosteroids. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Actions and Side Effects. Edema Decreased salt intake Increased potassium excretion Potassium supplements may be necessary.
Increased calcium excretion Use with caution in patients at increased risk of developing osteoporosis; calcium supplements may be necessary, especially in postmenopausal women.
Gastrointestinal Gastric irritation Take with meals to prevent gastric upset. Endocrine Hypercortisolism Cushingoid state , secondary adrenal insufficiency Associated with long-term use even at lower dosages Menstrual difficulties, including amenorrhea and postmenopausal bleeding Precipitation of diabetes mellitus Glucose intolerance, hyperglycemia In patients with diabetes, increased dosages of insulin or oral hypoglycemic agent and changes in diet should be expected.
Cardiovascular Hypertension Use with extreme caution in patients with recent myocardial infarction because of an apparent association with left ventricular free-wall rupture. Thromboembolism Use with caution in patients with thromboembolic disorders because of reports of rare increased blood coagulability. Thrombophlebitis CHF exacerbation Ocular Posterior subcapsular cataracts Prolonged use may result in increased intraocular pressure or damaged ocular nerve.
Use in patients with ocular herpes simplex may cause corneal perforation. Glaucoma May enhance secondary fungal or viral infections of the eye Musculoskeletal Muscle pain or weakness, muscle wasting, pathologic long bone or vertebral compression fractures, atrophy of protein matrix of bone, aseptic necrosis of femoral or humeral heads Use with caution in patients prone to development of osteoporosis; risk versus benefit should be reassessed if osteoporosis develops; elderly, debilitated or poorly nourished patients may be more prone to these effects.
Supplementation with calcium, 1, mg per day, and vitamin D, IU per day, is recommended. Neuropsychiatric Headache, vertigo, seizures, increased motor activity, insomnia, mood changes, psychosis Use with caution in patients with convulsive or psychiatric disorders.
Use may aggravate preexisting psychiatric conditions. Steroid-induced psychosis is dose-related, occurs within 15 to 30 days of therapy and is treatable if steroid therapy must be continued. Pseudotumor cerebri reported during withdrawal. Other Increased susceptibility to infections, masked symptoms of infections Contraindicated in patients with systemic fungal infections except to control drug reactions associated with amphotericin B [Fungizone] therapy.
Do not use live virus vaccinations during therapy. Reactions to skin tests may be suppressed. In most patients, endogenous corticosteroid secretions are equivalent to 5 to 7.
Recommended tapering schedules Tapering the dosage over 2 months or more may be necessary for patients on prolonged treatment more than 1 year. Depending on dosage, duration of therapy and risk of systemic disease, decrease dosage by the equivalent of 2. Then perform a challenge to determine the extent of HPA axis recovery. Depending on the results and patient's symptoms, therapy may be discontinued or a slower taper considered.
If symptoms do not subside when steroid dosage is adjusted, other causes must be considered. In certain severe illnesses or during acute flare ups, daily dosing may be re-initiated. Pneumocystis carinii Pneumonia. Pain Management. Alcoholic Hepatitis.
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