Corticosteroids, oral indications

Although steroids are effective in achieving remission of ulcerative colitis through their anti-inflammatory properties, they do not change the underlying disease process. In comparison with sulfasalazine or other aminosalicylates, corticosteroids seem to have a faster onset of action and induce remission in 2 to 4 weeks. Parenteral corticosteroids are indicated for severe ulcerative colitis. Once a response is achieved, IV corticosteroids should be converted to oral therapy. However, if there is no response from IV corticosteroids within 72 hours, surgery may be indicated. 

Mitotane (lysodren) is administered in initial daily oral doses of 2-6 g, usually given in 3 or 4 divided portions, but the maximal tolerated dose may vary from 2 to 16 g/day. Treatment should be continued for at least 3 months if beneficial effects are observed, therapy should be maintained indefinitely. Spironolactone should not be administered concomitantly, since it interferes with the adrenal suppression produced by mitotane. Treatment with mitotane is indicated for the palliation of inoperable adrenocortical carcinoma, producing symptomatic benefit in 30—50% of such patients. Although the administration of mitotane produces anorexia and nausea in 80% of patients, somnolence and lethargy in 34%, and dermatitis in 15—20%, these effects do not contraindicate the use of the drug at lower doses. Since this drug damages the adrenal cortex, administration of corticosteroids is indicated, particularly in patients with evidence of adrenal insufficiency, shock, or severe trauma. 

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 depends on the symptoms and severity of the exacerbation. Mild exacerbations can often be treated at home with an increase in bronchodilator therapy with or without oral corticosteroids (Fig. 12-3). Antibiotics are indicated only if there are clinical signs of airway infection (e.g., increased volume and change in color of sputum and/or fever). Moderate to severe exacerbations require management in the... 

Pain and joint function have been evaluated frequently in clinical trials administering hyaluronan to patients with OA. Results are conflicting, with some suggesting dramatic improvements and others indicating no effect. In one controlled trial, hyaluronan injections relieved pain to a similar extent as oral NSAIDs.29 Hyaluronan provides greater pain relief for a longer time than intraarticular corticosteroids, but corticosteroids work more rapidly.29... 

Systemic corticosteroids (Table 80-4) are indicated in all patients with acute severe asthma not responding completely to initial inhaled /J2-agonist administration (every 20 minutes for three to four doses). Prednisone, 1 to 2 mg/kg/day (up to 40 to 60 mg/day), is administered orally in two divided doses for 3 to 10 days. Because short-term (1 to 2 weeks), high-dose systemic steroids do not produce serious toxicities, the ideal method is to use a short burst and then maintain the patient on appropriate long-term control therapy with inhaled corticosteroids. 

Salbutamol is a selective beta2-receptor agonist indicated in the management of asthma as a bronchodilator relieving acute attacks. It may be used in combination with inhaled corticosteroids such as beclometasone. Salbutamol acts within a few minutes and tends to be short-acting, unlike salmeterol. Side-effects of salbutamol include tachycardia and palpitations. It does not cause drowsiness and does not precipitate oral candidiasis. Inhaled corticosteroids may precipitate oral candidiasis. 

VIII.b.1.3. Extensive disease. Rectal therapies are insufficient, and patients should receive, if outpatients, oral corticosteroids, and if in-patients oral or parenteral corticosteroids with full supportive treatment including parenteral fluids and blood transfusion. The need for intensive in-patient treatment is indicated by the presence of severe diarrhoea, anaemia, fever and tachycardia with radiographic evidence of colonic mucosal oedema on plain X-ray, or of toxic megacolon. 

ICS (Inhaled Corticosteroids) Indications Cough, dysphonia, oral thrush... 

The indications for therapy with SBC-5-IMNs in DMARD-Refractory RA are ESR > 40 mm (ESR of knee OA very rarely exceeds 40 mm) and VAS > 4. Patients are considered to have DMARD-Refractory RA (DR-RA) if optimal dosages of single and combined oral DMARDs (corticosteroids, hydroxychloroquine, sulphasalazine, and MTX) have been used for 2 months without lowering of the ESR with 1 mm or more, with a decrease of the swollen and tender joint count of less than 1 and the VAS still above 10 (scale 0-100) at month 1 and 2 compared with baseline. 

It is a cysteinyl leukotriene receptor antagonist indicated for the management of persistent asthma. It has been shown to have substantial blockade of airway leukotriene receptors 24 hours after oral dosing. Montelukast appears to be a useful alternative or adjunct to inhaled corticosteroid therapy in adults and an alternative to sodium cro-moglycate in children. 

Drug interactions No formal drug interaction studies have been carried out. Clinical trials have indicated that Pulmozyme can be effectively and safely used in conjunction with standard cystic hbrosis therapies including oral, inhaled, and/or parenteral antibiotics, bronchodila-tors, enzyme supplements, vitamins, oral or inhaled corticosteroids, and analgesics. 

Clinical studies of corticosteroids consistently show them to be effective in improving all indices of asthma control—severity of symptoms, tests of airway caliber and bronchial reactivity, frequency of exacerbations, and quality of life. Because of severe adverse effects when given chronically, oral and parenteral corticosteroids are reserved for patients who require urgent treatment, ie, those who have not improved adequately with bronchodilators or who experience worsening symptoms despite maintenance therapy. Regular or "controller" therapy is maintained with aerosol corticosteroids. 

Uses Severe, systemic fungal Infxns oral cutaneous candidiasis Action Binds ergosterol in the fungal membrane to alter permeability Dose Adults Peds. Test dose 1 mg IV adults or 0.1 mg/kg to 1 mg IV in children then 0.25—1.5 mg/kg/24 h IV over 2-6 h (range 25—50 mg/d or qod). Total dose varies w/ indication PO 1 mL qid Caution [B, ] Disp Inj SE -l K+/Mg2+ from renal wasting anaphylaxis reported, HA, fever, chills, nephrotox, X BP, anemia, rigors Notes X In renal impair pre-Tx w/ APAP antihistamines (Benadryl) X SE Interactions T Nephrotoxic effects W/ antineoplastics, cyclosporine, furosemide, vancomycin, aminoglycosides, T hypokalemia W/ corticosteroids, skeletal muscle relaxants EMS May cause electrolyte imbalances, monitor ECG OD May effect CV and resp Fxn symptomatic and supportive... 

An important feature of thyrostats, beta-agonists, and corticosteroids is that they are in general orally active. This means that they can be given via the fodder or drinking water, leaving no trace of percutaneous administration, which is one of the annoying indications when orally inactive steroids are injected. 

Eor inhalation exposures, move the patient to an uncontaminated atmosphere and administer oxygen as indicated. Insure a patent airway. Treat broncho-spasm with inhaled pi agonists and oral or parenteral corticosteroids. Again monitor the level of consciousness, EKG, oxygen saturation, liver, and renal functions carefully. Cardiac sensitization has occurred with other compounds in this class so EKG monitoring should be carried out carefully. Epinephrine or other S-adrenergic agents should be immediately available should arrhythmias occur. 

Depending on the location of ocular inflammation, a specific corticosteroid in a specific dosage form may be chosen. For instance, a corticosteroid of high potency, such as prednisolone acetate, fiuorometholone, or dexamethasone, may be chosen for deep-seated inflammation of the uveal tract. Further treatment of such inflammation may take the form of subtenon injections or oral (systemic) administration of selected corticosteroids, depending on the indication and the dosage forms available. For inflammation of a more superficial nature, the lower strengths of prednisolone acetate or the lower-potency corticosterioids, such as hydrocortisone or medrysone, will usually be chosen. 

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