Corticosteroids adverse reactions

Klein-Gitelman MS, Pachman LM. Intravenous corticosteroids adverse reactions are more variable than expected in children. J Rheumatol 1998 25(10) 1995-2002. 

Corticosteroids may be given in high doses for some arthritic disorders. Many adverse reactions are associated with high-dose and long-term corticosteroid therapy. Chapter 50 discusses some of the adverse reactions associated with corticosteroid therapy. A comprehensive list of adverse reactions is provided in Display 50-2. Contraindications, precautions, and interactions of the corticosteroids are discussed in Chapter 50. 

Which of the following adverse reactions would lead die nurse to suspect Cushingoid appearance in a patient taking a corticosteroid ... 

Adverse reactions associated with administration of the corticosteroid ophthalmic preparations include elevated IOP with optic nerve damage, loss of visual acuity, cataract formation, delayed wound healing, secondary ocular infection, exacerbation of comeal infections, dry eyes, ptosis, blurred vision, discharge, ocular pain, foreign body sensation, and pruritus. 

Patients with chronic idiopathic urticaria, who develop cutaneous reactions in response to aspirin, display certain similarities in eicosanoid profile with AIA. The mechanism of the reactions is often related to COX-1 inhibition [18]. Therefore, aspirin and all drugs that inhibit COX-1 should be avoided in patients who already have had cutaneous reactions to NSAID. Coxibs are usually well tolerated, although occasional adverse reactions have been reported [19, 20]. For treatment of the reactions, antihistamines are usually sufficient, but in more severe cases adrenaline and corticosteroids may be warranted. 

Common mild local adverse reactions include induration and swelling at the injection site. More severe reactions (generalized urticaria, broncho-spasm, laryngospasm, vascular collapse, and death from anaphylaxis) occur rarely. Severe reactions are treated with epinephrine, antihistamines, and systemic corticosteroids. 

Adverse reactions to sulfites appear to occur mainly among a small percentage of asthmatics, but it is possible for individuals without asthma to be sulfite sensitive. It is typically more of a problem in individuals with severe asthma who are also taking corticosteroid drugs to control their disease. Among these individuals, the prevalence of sulfite sensitivity is about 8%, while it is about 1% in asthmatics who are not dependent on steroids (Taylor and Bush, 1986). 

Adverse reactions of corticosteroids are frequent with the long-term immunosuppressive regimens which are often needed and include an increased risk of infections, Cushing-like symptoms, hypertension, hyperglycemia, osteoporosis, growth retardation in children and mental reactions such as dysphoria, psychosis and depression. 

Nasal corticosteroids are effective in vasomotor rhinitis, but because of the duration of the disorder, certain caution is advised to avoid systemic effects and local adverse reactions after long-term use. Ipratropium bromide spray works well if the dominating problem is runny nose. 

Drug interactions In a randomized, double-blind study, Zenapax or placebo was added to an immunosuppressive regimen of cyclosporine, mycophenolate mofetil, and steroids to assess tolerability, pharmacokinetics, and drug interactions. The addition of Zenapax did not result in an increased incidence of adverse events or a change in the types of adverse events reported. The following medications have been administered in clinical trials with Zenapax with no incremental increase in adverse reactions cyclosporine, mycophenolate mofetil, ganciclovir, acyclovir, azathioprine, and corticosteroids. 

Drug interactions No formal drug-drug interaction studies have been conducted. The following medications have been administered in clinical trials with Simulect with no incremental increase in adverse reactions azathioprine, corticosteroids, cyclosporine, mycophenolate mofetil, and muromonab-CD3. 

Lopez-Serrano MC, Moreno-Ancillo A, Contreras J, Ortega N, Cabanas R, Barranco P, Munoz-Pereira M. Two cases of specific adverse reactions to systemic corticosteroids. J Invest Allergol Clin Immunol 1996 6(5) 324-7. 

Quintiliani R. Hypersensitivity and adverse reactions associated with the use of newer intranasal corticosteroids for allergic rhinitis. Curr Ther Res Clin Exp 1996 57 478-88. 

What are some important adverse reactions to corticosteroids ... 

Drug intolerance often limits the usefulness of agents used to treat IBD. Many patients receiving sulfasalazine, mesalamine, corticosteroids, metronidazole, azathioprine, mercaptopurine, or infliximab experience some undesired effects. In some cases, these adverse effects can be significant and require discontinuation of the therapy. Knowledge of the common or important adverse reactions will assist in avoiding or minimizing their effects. 

Adverse reactions to corticosteroids are well recognized and may occur when corticosteroids are used for any indication. However, there is a greater potential for adverse effects when corticosteroids are used for the treatment of IBD because high doses must often be used for... 

---