Corticosteroids, oral

Patients with IBD, particularly those with CD, are also at risk for bone loss. This may be a function of malabsorption or an effect of repeated courses of corticosteroids. Patients with IBD should receive a baseline bone density measurement prior to receiving corticosteroids. Vitamin D and calcium supplementation should be used in all patients receiving long-term corticosteroids. Oral bisphosphonate therapy may also be considered in patients receiving prolonged courses of corticosteroids or in those with osteopenia or osteoporosis. 

The medical success of these drugs gave new emphasis to the pharmaceutical industry, which was boosted further by the commencement of industrial-scale penicillin manufacture in the early 1940s. Around this time, many of the current leading pharmaceutical companies (or their forerunners) were founded. Examples include Ciba Geigy, Eli Lilly, Wellcome, Glaxo and Roche. Over the next two to three decades, these companies developed drugs such as tetracyclines, corticosteroids, oral contraceptives, antidepressants and many more. Most of these pharmaceutical substances are manufactured by direct chemical synthesis. 

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. 

Corticosteroids Oral, IV, IM, IA, and month Glucose blood pressure Same as initial... 

Several studies have been conducted, including some small randomised studies, to assess the use of ciclosporin in Crohn s disease. The evidence suggests that intravenous ciclosporin can induce disease remission in severe flares of ulcerative colitis that are unresponsive to corticosteroids. Oral ciclosporin has only been shown to be useful as a bridging treatment between intravenous ciclosporin and more long-term maintenance strategies. 

Diabetes mellitus Thiazide diuretics, furosemide, corticosteroids, oral contraceptives Hyperglycemia aggravates diabetic control... 

Many attempts have been made to determine whether medications were influential as a risk factor. Although use of a prescription or nonprescription medication did not differ substantially between case patients and controls, it appeared that the use of an antidepressant or psychotropic medication (any antipsychotic, antidepressant, benzodiazepines, and/or other anxiolytic) could increase the risk of developing EMS.22-67 It is of interest that a number of medications, such as corticosteroids, oral contraceptives, and estrogen, which can alter tryptophan metabolism, have not been determined to have an effect on the development of EMS. Actually, some clinicians have postulated that EMS itself may be caused by or related to abnormal tryptophan metabolism.42 68... 

Cisplatin (Neoplatin, Platinol) Corticosteroids, oral or IV Cyclophosphamide (Cytoxan, Endoxana) Cytarabine (Cytosar)... 

Nonspecific immunosuppressive therapy in an adult patient is usually through cyclosporin (35), started intravenously at the time of transplantation, and given orally once feeding is tolerated. Typically, methylprednisone is started also at the time of transplantation, then reduced to a maintenance dose. A athioprine (31) may also be used in conjunction with the prednisone to achieve adequate immunosuppression. Whereas the objective of immunosuppression is to protect the transplant, general or excessive immunosuppression may lead to undesirable compHcations, eg, opportunistic infections and potential malignancies. These adverse effects could be avoided if selective immunosuppression could be achieved. Suspected rejection episodes are treated with intravenous corticosteroids. Steroid-resistant rejection may be treated with monoclonal antibodies (78,79) such as Muromonab-CD3, specific for the T3-receptor on human T-ceUs. Alternatively, antithymocyte globulin (ATG) may be used against both B- and T-ceUs. 

Improvements in asthma treatment include the development of more effective, safer formulations of known dmgs. The aerosol adrninistration of P2-agonists or corticosteroids results in a decrease in side effects. Also, the use of reUable sustained release formulations has revolutionized the use of oral xanthines which have a very narrow therapeutic index (see Controlled release technology). For many individuals, asthma symptoms tend to worsen at night and the inhaled bronchodilatots do not usually last through an entire night s sleep (26,27). 

There are few definitive data to substantiate the efficacy of LTRA therapy in refractory asthma, except for patients with aspirin-sensitive asthma. This is a fairly uncommon form of asthma that occurs generally in adults who often have no prior (i.e., childhood) history of asthma or atopy, may have nasal polyposis, and who often are dependent upon oral corticosteroids for control of their asthma. This syndrome is not specific to aspirin but is provoked by any inhibitors of the cycloxygenase-1 (COX-1) pathway. These patients have been shown to have a genetic defect that causes... 

The topical and oral use of retinoids for treatment of hyperkeratotic disorders such as psoriasis and Darier s disease has long been established. Systemic retinoid therapy is often combined with topical diugs such as corticosteroids, dithranol, tar, and also UVA/UVB phototherapies where synergistic effects have been reported. 

The superficial mycotic infections occur on the surface of, or just below, the skin or nails. Superficial infections include tinea pedis (athlete s foot), tinea cruris (jock itch), tinea corporis (ringworm), onychomycosis (nail fungus), and yeast infections, such as those caused by Candida albicans. Yeast infections or those caused by C. albicans affect women in the vulvovaginal area and can be difficult to control. Women who are at increased risk for vulvovaginal yeast infections are those who have diabetes, are pregnant, or are taking oral contraceptives, antibiotics, or corticosteroids. 

CORTICOSTEROID INHALANTS. The inhalers, particularly die corticosteroid or mast cell aerosols, may cause tiiroat irritation and infection with Candida albicans. The nurse instructs the patient to use strict oral hygiene, cleanse die inhaler as directed in die package directions, and use die proper technique when taking an inhalation. These interventions will decrease die incidence of candidiasis and help to soodie die throat. Occasionally an antifungal drug may be prescribed by die primary health care provider to manage the candidiasis. 

The following drugp have a decreased pharmacologic effect when administered with an antacid corticosteroids, digoxin, chlorpromazine, oral iron products, isoniazid, phenothiazines, ranitidine, phenytoin, valproic acid, and the tetracyclines. 

In general, treatment of the asthma underlying NSAlDs sensitivity should follow standard asthma guidelines. This type of asthma is often severe and frequently high doses of inhaled corticosteroids and daily doses of oral corticosteroids are necessary. A special treatment option is a chronic desensitization to aspirin [8]. Desensitization and aspirin maintenance is routinely used in some centers for treatment of chronic rhinusinusitis with nasal polyposis. It is the only available procedure which allows AIA patients with ischemic heart disease to use aspirin. During the state of desensitization to aspirin, not only aspirin but almost all strong NSAIDs are tolerated, so desensitization and NSAID maintenance could be used for treatment of rheumatic disease or chronic pain syndromes. 

Hughes, G.S., Francom, S.F., Means, L.K., Bohan, D.F., Caruana, C. and Holland, M. (1992). Synergistic effects of oral non-steroidal drugs and topical corticosteroids in the therapy of sunburn in humans. Dermatology 184, 54—58. 

Systemic corticosteroids if no immediate response or incomplete response to aggressive inhaled P2-adrenergic agonist therapy, if patient recently received an oral corticosteroid, or if the episode is considered severe... 

Consider in most cases a short-course of an oral corticosteroid... 

A greater than or equal to 12% (at least 200 mL) improvement in FEV after an inhaled bronchodilator demonstrates a reversible obstruction. A 2- to 3-week course of oral corticosteroids may be necessary to demonstrate reversibility in airway obstruction. 

---