Corticosteroid administration

Maintenance and prophylactic treatment of asthma for asthma patients who require systemic corticosteroid administration when adding an inhaled corticosteroid may reduce or eliminate the need for systemic corticosteroids... 

There is no evidence that intravenous corticosteroid administration is more effective than oral administration, and the oral route is preferred in acute severe asthma.3 There are also few data to guide selection of initial corticosteroid doses. Recommended doses for acute severe asthma are shown in Table 11-5, page 227 however, recent data indicate that... 

Treatment options include corticosteroid administration to the mother prior to a cesarean section to induce surfactant production, direct tracheal instillation of surfactant, and in the most severe cases, mechanical ventilation. 

Contraindications Hypersensitivity to corticosteroids, administration of live virus vaccine, peptic ulcers (except in life-threatening situations), systemic fungal infection... 

Corticosteroids potentially used in food-producing animals include a variety of compounds such as cortisone, cortisol, prednisone, prednisolone, methylpredniso-lone, betamethasone, dexamethasone, flumethasone, fluoroprednisolone, isoflu-predone, and triamcinolone. Corticosteroid administration to feedlots as growth-promoting agents has been recently introduced illicitly in animal production because of their ability to promote water retention in the body. This use has been strongly enhanced for commercial reasons, in order to produce meat more appealing to consumers, due to the juicy and lean look. It is therefore crucial to rely on accurate, sensitive and specific analytical methods to measure residues in biological samples. 

Elliott JP, Radin TG. The effect of corticosteroid administration on uterine activity and preterm labor in high-order multiple gestations. Obstet Gynecol 1995 85(2) 250 1. 

Cortisol Suppression by Corticosteroids The model presented here allows the consideration of external corticosteroid administration as a perturbation of the cortisol secretion system. As a matter of fact, corticosteroids cause a temporary diminution of plasma cortisol levels [522]. Assuming that the drug follows one-compartment model disposition with first-order input and output, the effect-site [525] concentration is described by the following equation [417] ... 

The effect-site concentration of the corticosteroids can be considered to affect one or more parameters of the model described by (11.12). This must be implemented so that the presence of y (t) suppresses the cortisol secretion in accordance with the experimental data. Instead of g (t), the parameter describing the circadian rhythm, a new parameter g (t) was introduced to include the effect of corticosteroid administration following a receptor reduction ... 

Baseline levels of urea and creatinine can be highly variable. Plasma urea reflects hepatic synthesis rate and will be elevated with increased protein catabolism (increased dietary protein intake, gastrointestinal hemorrhage, fever, severe bums, corticosteroid administration, sustained exercise or muscle wasting),... 

Dexamethasone may cause side-effects typical of corticosteroid administration. Many of its more serious adverse effects occur on long-term treatment, while other generally less serious effects may become apparent during shortterm treatment periods. These may include ... 

Table 12-3 Advantages and Disadvantages of the Three Routes of Corticosteroid Administration ...

The frequency of corticosteroid administration varies with the intensity of the reaction. For mild anterior uveitis (1-1- cells and flare), dosing every 4 hours may be sufficient. Moderately severe anterior uveitis may be managed with 1% prednisolone acetate or similar medication every 2 to 3 hours. In severe cases steroids may be dosed hourly or even more frequently. Corticosteroid ointments may be used at bedtime, though the duration of this drug modality only extends the medication s efficacy for perhaps an additional hour or 2. In the case of severe anterior uveitis, it is probably better to have the patient awaken every 2 to 3 hours and instill another drop. 

Corticosteroid administration by systemic (oral or intravenous), topical (ophthalmic and cutaneous), injected (periocular and subcutaneous), and inhalation and possibly nasal routes can elevate lOP In patients who are steroid responders, oral steroids produce approximately 60% the increase in lOP as compared with topical agents, most likely because of differences in achieved anterior chamber concentrations of the drug. Those with primary open-angle glaucoma respond to steroids at a rate of 46% to 92% compared with 18% to 36% of... 

Induction of ocular hypertension after corticosteroid administration depends on the specific drug, the dose, the route and frequency of administration, and the corticosteroid responsiveness of the patient. Generally, patients with elevated lOP are asymptomatic, so examination with applanation tonometry is the key to diagnosis. If the patient shows a steroid responsiveness, the onset of lOP elevations is not immediate but occurs after approximately 2 weeks of use. However, it can occur many weeks later, and this time to onset is generally longer for systemic steroids. In responsive patients the level of lOP rise with systemic steroids averages approximately 60% of that produced by topically applied steroids. 

I-BOP-induced aortic contractions were decreased 50% in dexamethasone-treated rabbits, and this functional effect of corticosteroid administration was accompanied by an 25% reduction in aortic cell membrane TP receptor number (186). Although the functional and receptor changes were corrrelated, the magnitude of the reduction in receptor density was small. It is possible that the effects of corticosteroids on aortic contraction were due to an influence on post-receptor events as well as on receptors (186). 

Sodium stibogluconate (Pentostam) is an organic pentavalent antimony compound it may cause anorexia, vomiting, coughing and substemal pain. Used in mucocutaneous leishmaniasis, it may lead to severe irrflammation around pharyngeal or tracheal lesions which may require corticosteroid administration to control. Meglumine antimoniate is similar. 

Topical adrenal steroid reduces epidermal cell division, and application, especially under occlusive dressings, can be very effective, but increasing the doses (concentrations) becomes necessary and reboimd, which may be severe, follows withdrawal. For this reason potent corticosteroid should never be used except for lesions on the scalp, palms and soles. Systemic corticosteroid administration should be avoided, for high doses are needed to suppress the disease, which is liable to recur in a more... 

The principal adverse effects of chronic corticosteroid administration are ... 

Lipworth BJ, Aziz 1. Bronchodilator response to albuterol after regular formoterol and effects of acute corticosteroid administration. Chest 2000 117(l) 156-62. 

Postoperative analgesia from morphine has been shown to be the most effective if administered at the completion of the procedure (Brandsson et al 2000, Reuben et al 2001, Tetzlaff et al 2000). In these cases, it appears that the postoperative use of morphine allows the clinician to reduce both the level and the duration of other analgesics. This is not to say that the only potential benefit of morphine is in the postoperative patient. Morphine has also been shown to be of equivalent effect to corticosteroid administration in other forms of chronic arthritides (Keates et al 1999, Stein et al 1999). The reductions in inflammatory cell influx, reduced edema formation and analgesia provided with minimal systemic effects make intraarticular morphine a very attractive postoperative therapy. I most commonly use a combination of 5-15 mg morphine with 6 mg lidocaine for postoperative analgesia and have seen no untoward effects. The beneficial effects with respect to improved analgesia and ability to reduce the usage of NSAIDs remains to be proven. 

The timing of corticosteroid administration has been pinpointed to interact with the diurnal rhythm of the hypothalamic-pituitary-adrenal axis in humans (Meibohm et al 1997). Dose timing has a pivotal effect on the safety profile and consequently the risk-benefit ratio of inhaled corticosteroids. In humans, maximum adrenal suppression occurs with the administration of aerosolized corticosteroids in the early morning hours, whereas endogenous cortisol production is least disrupted by administration in the afternoon. The circadian pattern results from the... 

Beclometasone dipropionate is the most widely dispensed inhaled anti-inflammatory agent for astfunatic human patients. Inhaled beclometasone dipropionate reduces inflammatory cell populations in bronchoalveolar lavage fluid, controls clinical signs of airway obstruction and improves parameters of pulmonary function in human asthmatics. Consequently, aerosolized beclometasone dipropionate is the first line of therapy for mod-erate-to-severe allergic airway disease in human patients. Aerosolized beclometasone does not cause adrenal suppression in asthmatic human patients at therapeutic dosages (800-1600 xg/day) and initiation of beclometasone therapy as a replacement for systemic corticosteroid administration permits recovery of the hypothalamic-pituitary-adrenal axis (Barnes et al 1998). 

Schimke, R. T., All conditions leading to protein breakdown and resulting in increase in urea excretion, such as high protein diet, starvation or corticosteroid administration producing an increase in all 5 enzymes. J. Biol. Chem. 238, 1012-1018 (1963). 

Model for Simply Enhanced Genomic Marker TAT mRNA Induction by Corticosteroid Administration Developed by Ramakrishnan et al. JPP 29 1-24 (2002)... 

Since the two meta-analyses in 1995, five prospective, randomized, controlled trials of low-dose corticosteroids in vasopressor-dependent septic shock patients (n = 505) have been published. " These smdies used moderate physiologic doses (200 to 300 mg/day) of hydrocortisone. A meta-analysis of these studies showed that steroid therapy was associated with an overall improvement in survival rate (odds ratio [OR] 1.52, 95% confidence interval [Cl] 1.03-2.27 p =. 036) and shock reversal (OR 4.79, 95% Cl 2.07-11.11 p =. 001). These effects were beneficial in both responders and nonresponders to corticotrophin stimulation testing (p =. 63 and p =. 75, respectively). These smdies also showed that low-dose corticosteroid administration improves hemodynamics and reduces the duration of vasopressor support. " All these studies differ from earlier smdies in that steroids were admimstered later in septic shock (23 hours versus less than 2 hours p =. 02). In these studies, steroids were administered longer (6 days versus 1 day p =. 004), doses were tapered, lower doses were used (hydrocortisone eqmvalents 1209 mg versus 23,975 mg p =. 01), aU patients received high doses of catecholamine vasopressors, and control groups had higher mortality rates (mean 57% versus 34% p =. 03). Since only one of the five studies showed a mortality benefit of low-dose steroids in septic shock, further research is required to confirm this finding. ... 

A number of clinical trials have demonstrated the benefit of administering antenatal corticosteroids for the prevention of respiratory distress syndrome, intraventricular hemorrhage, and death in infants delivered prematurely. The current chnical recommendation is to administer betamethasone 12 mg intramuscularly every 24 hours for two doses or dexamethasone 6 mg intramuscularly every 12 hours for four doses to pregnant women between 24 and 34 weeks gestation who are at risk for preterm delivery within the next 7 days. Benefits from antenatal corticosteroids are believed to begin within 24 hours. It has been found that repeat corticosteroid administration does not produce any improvement in outcomes for infants and may trend toward harm. ... 

A careful history should be taken when one of the differential diagnoses is ulcerative colitis because corticosteroid administration has the potential to unmask amebiasis and produce toxic megacolon. All patients diagnosed as having inflammatory bowel disease should have their stools examined carefully and serologic testing done for amebiasis to avoid the serious consequence that results from the administration of corticosteroids. 

Headaches are usually manageable with mild analgesics ATRA syndrome treated with corticosteroid administration (initiate when WBC >10,000) and/or holding ATRA until symptoms resolve bone pain typically responds to mild analgesics teratogenic contraindicated in pregnancy female patients should be educated about proper contraceptive measures... 

Corticosteroids have been used to treat a variety of ocular diseases. Traditionally, delivery of corticosteroids for posterior-segment eye diseases has been achieved through oral systemic therapy and periocular injections. Oral corticosteroids have not been widely used to treat DME, but when used for posterior inflammatory uveitis, they require high concentrations to reach therapeutic levels in the posterior segment. These high doses often result in systemic side effects (24). Periocular corticosteroid administration often must be repeated and may be associated with complications such as ptosis and inadvertent needle penetration of the globe. 

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