Corticosteroid contraindications

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. 

The corticosteroids are contraindicated in patients with hypersensitivity to the corticosteroids, acute bron-chospasm, status asthmaticus, or other acute episodes of... 

The topical corticosteroids are contraindicated in patients with known hypersensitivity to the drug or any component of the drug, as monotherapy for bacterial skin... 

The corticosteroid ophthalmic preparations are contraindicated in patients with acute superficial heq es simplex keratitis, fungal disease of the eye, or viral diseases of the eye, and after removal of a superficial comeal foreign body. 

Systemic corticosteroids are a useful option in patients with contraindications to NSAIDs or colchicine (primarily renal impairment) or polyarticular attacks, especially in elderly patients. A single intramuscular injection of a long-acting corticosteroid such as triamcinolone hexacetonide may be used. Oral agents may be needed, especially for severe attacks. Prednisone 40 to 60 mg (or an equivalent dose of another agent) is given daily, with a gradual taper over 2 weeks. 

Corticosteroids may be used to treat acute attacks of gouty arthritis, but they are reserved primarily for patients with a contraindication or who are unresponsive to NSAID or colchicine therapy. Patients with multiple-joint involvement may also benefit. 

A single intramuscular injection of a long-acting corticosteroid (e.g., methylprednisolone acetate) can be used as an alternative to the oral route if patients are unable to take oral therapy. If not contraindicated, low-dose colchicine can be used as adjunctive therapy to injectable corticosteroids to prevent rebound flare-ups. 

Management of an acute attack of gout involves the use of high doses of nonsteroidal anti-inflammatory agents (NSAIDs). Colchicine is useful in patients with heart failure where the use of NSAIDs is contraindicated because of water retention. Allopurinol and other uricosuric agents are not indicated for acute attacks as they may aggravate the condition. The use of an intra-articular corticosteroid injection in gout is unlicensed. 

Epidural/Intrathecal- Presence of infection at the injection microinfusion site concomitant anticoagulant therapy uncontrolled bleeding diathesis parenterally administered corticosteroids within a 2-week period, other concomitant drug therapy or medical condition that would contraindicate the technique of epidural or intrathecal analgesia acute bronchial asthma upper airway obstruction. 

Iritis, which affects up to 25% of patients undergoing fomivirsen therapy, can be managed with topical corticosteroids. Vitreitis and increased intraocular pressure may also result from fomivirsen administration. Fomivirsen is contraindicated in patients who have been treated with cidofovtr within the previous 2 to 4 weeks because cidofovir increases the risk of ocular inflammation. 

Contraindications Hypersensitivitytoalclometasone, other corticosteroids, oranyof its components. 

Contraindications History of hypersensitivity to amcinonide or other corticosteroids. 

Contraindications Hypersensitivity to any corticosteroid or its components, persistently positive sputum cultures ior Candida albicans, primary treatment of status asth-maticus, systemic fungal infections, untreated localized infection involving nasal mu-... 

Contraindications Hypersensitivity to clocortolone pivalate or other corticosteroids viral, fungal, or tubercular skin lesions... 

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

Contraindications Perforated eardrum, history of hypersensitivity to desonide or other corticosteroids... 

Contraindications Administration of live virus vaccines, especially smallpox vaccine hypersensitivity to corticosteroids or tartrazine peptic ulcer disease (except life-threatening situations) systemic fungal infection Topical Marked circulation impairment... 

Moderate-severe persistent intranasal corticosteroids are the drug of choice. Antihistamines, intranasal decongestants, and sodium cromoglicate are alternatives if steroids are contraindicated, or can be used as add-on drugs. Ipratropium bromide is useful for people with persistent watery effusion. 

Phosgene. Transient irritation (eyes, nose, throat, and sinus). Bronchospasm. Pulmonary edema. Apnea. Hypoxia Decontamination Wash away all residual liquid with copious water, remove clothing Symptomatic care ABCs, hydrate, positive pressure O2 for pulmonary edema Bronchospasm Beta-agonists (albuterol), corticosteroids INH/IV, furosemide contraindicated Hypoxia Oxygen... 

Because side effects can complicate the use of corticosteroids, a careful history and certain tests may be advisable, particularly if a patient may require prolonged ocular therapy. Steroids should be used with great caution in patients with diabetes mellitus, infectious disease, chronic renal feilure, congestive heart feilure, and systemic hypertension. Systemic administration is generally contraindicated in patients with peptic ulcer, osteoporosis, or psychoses. Topical steroids should be used with caution and only when necessary in patients with glaucoma. 

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