Corticosteroids discontinuation

When corticosteroid use is discontinued, the dosage must be tapered gradually over several days If high dosages have been given, it may take a week or more to taper the dosage. 

CORTICOSTEROIDS. When the patient is receiving one of these drugs on alternate days (alternate-day therapy), the drug must be given before 9 AM. It is extremely important that these drug not be omitted or discontinued suddenly. 

Bronchospasm may occur after administration of the inhaled corticosteroids If an immediate increase in wheezing indicating bronchospasm occurs after administration of a corticosteroid inhalant, the nurse immediately administers a shortacting inhaled bronchoditator. The inhaled corticosteroid is discontinued and an alternate treatment started. 

If it is necessary to use systemic corticosteroids for long-term control therapy, once-daily or every-other-day therapy should be used and repeated attempts should be made to decrease the dose or discontinue the drug. Withdrawal of chronic therapy may precipitate adrenal failure or unmask underlying inflammatory disorders such as Churg-Strauss syndrome. 

Upon discontinuation of inhaled corticosteroids some patients may experience deterioration in lung function and an increase in dyspnea and mild exacerbations it is reasonable to reinstitute the medication in these patients.25 Completion of ongoing clinical trials assessing mortality should help to clarify the role of corticosteroid treatment of COPD. 

Evaluate patients receiving systemic corticosteroid therapy for improvement in symptoms and opportunities to taper or discontinue steroid therapy. For patients using more than 5 mg daily of prednisone for more than 2 months or for steroid-dependent patients consider the following ... 

In general, contributing factors such as diuretics, nasogastric suction, and corticosteroids should be discontinued if possible. Any fluid deficits should be treated with IV normal saline. Recognize that patients with varieties of metabolic... 

If necrotic temporarily discontinue consult dermatologist do not use topical corticosteroids... 

Treatment Discontinue or minimize immunosuppressants Surgical, radiologic, or antineoplastic therapy Do not abruptly withdraw corticosteroids... 

Topical corticosteroids are employed in some cases of bacterial keratitis. The suppression of inflammation may reduce corneal scarring. However, local immunosuppression, increased ocular pressure, and reappearance of the infection are disadvantages to their use. There is no conclusive evidence that they alter clinical outcomes. If the patient is already on topical corticosteroids when the keratitis occurs, discontinue use until the infection is eliminated.19... 

The recommended dose is prednisone 30 to 60 mg (or an equivalent dose of another corticosteroid) orally once daily for 3 to 5 days. Because rebound attacks may occur upon steroid withdrawal, the dose should be gradually tapered in 5-mg increments over 10 to 14 days and discontinued. 

Most maculopapular reactions disappear within a few days after discontinuing the agent, so symptomatic control of the affected area is the primary intervention. Topical corticosteroids and oral antihistamines... 

Photosensitivity reactions typically resolve with drug discontinuation. Some patients benefit from topical corticosteroids and oral antihistamines, but these are relatively ineffective. Systemic corticosteroids (e.g., oral prednisone 1 mg/kg/day tapered over 3 weeks) is more effective for these patients. 

Pemphigoid-type Pemphigoid-type reactions characterized by bullous lesions have required discontinuation of penicillamine and treatment with corticosteroids. 

A iate rash A late rash is less commonly seen, usually after 6 months or more of treatment, and requires drug discontinuation. It usually appears on the trunk, is accompanied by intense pruritus, and is usually unresponsive to topical corticosteroids. 

Infections Localized fungal infections with Candida albicans or Aspergillus niger have occurred in the mouth, pharynx, and occasionally in the larynx. The incidence of clinically apparent infection is low, and may require treatment with appropriate antifungal therapy or discontinuance of aerosol steroid treatment. Use inhaled corticosteroids with caution, if at all, in patients with active or quiescent tuberculous infection of the respiratory tract, untreated systemic fungal, bacterial, parasitic or... 

Flunisolide - Because of the possibility of higher systemic absorption, monitor patients using flunisolide for any evidence of systemic corticosteroid effect. If such changes occur, discontinue slowly, consistent with accepted procedures for discontinuing oral corticosteroids. When flunisolide is used chronically at 2 mg/day, monitor patients periodically for effects on the HPA axis. 

NSAIDs and oral corticosteroids may be continued. Onset of action generally occurs between 4 and 8 weeks. If insufficient benefit is seen and tolerability is good (including serum creatinine less than 30% above baseline), the dose may be increased by 0.5 to 0.75 mg/kg/day after 8 weeks and again after 12 weeks to a maximum of 4 mg/kg/day. If no benefit is seen by 16 weeks of therapy, discontinue. There is limited P.1164... 

May allow discontinuation of chronic systemic corticosteroids in many patients... 

A dental examination with appropriate preventive dentistry should be considered prior to treatment with bisphosphonates in patients with concomitant risk factors (e.g., cancer, chemotherapy, corticosteroid use, poor oral hygiene). While on bis-phosphonate treatment, patients with concomitant risk factors should avoid invasive dental procedures if possible. For patients who develop osteonecrosis of the jaw while on bisphosphonate therapy, dental surgery may exacerbate the condition. For patients requiring dental procedures, there are no data available to suggest whether discontinuation of bisphosphonate treatment reduces the risk of osteonecrosis of the jaw. 

Long-term control of bronchial asthma, assists in reducing or discontinuing oral corticosteroid therapy inhalafion 2 inhalafions fwice a day, morning and evening. Maximum 4 inhalafions fwice a day. 

Systemic or inhaled corticosteroids should not be abruptly discontinued upon initiation of omalizumab therapy... 

Urgent treatment is often begun with an oral dose of 30-60 mg prednisone per day or an intravenous dose of 1 mg/kg methylprednisolone every 6 hours the daily dose is decreased after airway obstruction has improved. In most patients, systemic corticosteroid therapy can be discontinued in a week or 10 days, but in other patients symptoms may worsen as the dose is decreased to lower levels. Because adrenal suppression by corticosteroids is related to dose and because secretion of endogenous corticosteroids has a diurnal variation, it is customary to administer corticosteroids early in the morning after endogenous ACTH secretion has peaked. For prevention of nocturnal asthma, however, oral or inhaled corticosteroids are most effective when given in the late afternoon. 

If asthmatic symptoms occur frequently or if significant airflow obstruction persists despite bronchodilator therapy, inhaled corticosteroids should be started. For patients with severe symptoms or severe airflow obstruction (eg, FEVi < 50% predicted), initial treatment with a combination of inhaled and oral corticosteroid (eg, 30 mg/d of prednisone for 3 weeks) treatment is appropriate. Once clinical improvement is noted, usually after 7-10 days, the oral dose should be discontinued or reduced to the minimum necessary to control symptoms. 

Infliximab intravenous infusions result in acute adverse infusion reactions in up to 10% of patients, but discontinuation of the infusion for severe reactions is required in less than 2%. Infusion reactions are more common with the second or subsequent infusions than with the first. Early mild reactions include fever, headache, dizziness, urticaria, or mild cardiopulmonary symptoms that include chest pain, dyspnea, or hemodynamic instability. Reactions to subsequent infusions may be reduced with prophylactic administration of acetaminophen, diphenhydramine, or corticosteroids. Severe acute reactions include significant hypotension, shortness of breath, muscle spasms, and chest discomfort such reactions may require treatment with oxygen, epinephrine, and corticosteroids. 

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