Corticosteroids, risk factor

Risk factors for NSAID-induced peptic ulcers and complications are presented in Table 15-2. Several important principles should be considered when estimating the risk for developing PUD in a patient taking an NSAID (1) risk factors are generally additive (2) some risk factors (e.g., corticosteroid therapy) are not by themselves a risk factor for ulceration but increase PUD risk substantially when combined with NSAID therapy and (3) many of the risk factors postulated to increase PUD... 

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-... 

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. 

Osteoporosis is also common in those on long-term corticosteroid therapy (for example patients with autoimmune hepatitis or coexisting inflammatory bowel disease). Patients with chronic liver disease may also have other risk factors for osteoporosis related to their disease state. These include vitamin D deficiency, excessive alcohol consumption, poor diet, physical inactivity and low body mass index. Oestrogen deficiency in the postmenopausal stage further increases the risk. 

All NSAIDs have the potential to cause gastric and duodenal ulcers and bleeding through direct (topical) or indirect (systemic) mechanisms. Risk factors for NSAID-associated ulcers and ulcer complications (perforation, gastric outlet obstruction, GI bleeding) include increased age, comorbid medical conditions (e.g., cardiovascular disease), concomitant corticosteroid or anticoagulant therapy, and history of peptic ulcer disease or upper Gl bleeding. 

Palmer LB, Greenberger HE, Schrfif MJ Corticosteroid treatment as a risk factor for invasive aspergillosis in patients with lung disease. Thorax 1991 46 15-20. 

Epilepsy and osteoporosis are very common and frequently overlap. Nevertheless, the prevalence of low bone density appears to be disproportionately higher in patients with epilepsy, and patients with epilepsy have an excessive risk of fractures. A meta-analysis of 94 cohort studies and 72 case-control studies has shown that anticonvulsant treatment is highly associated with fractures (relative risk over 2) (117). Other risk factors were low body weight, weight loss, physical inactivity, consumption of corticosteroids, primary hjrperparathjroidism, type 1 diabetes melhtus, anorexia nervosa, gastrectomy, pernicious anemia, and age over 70 years. 

Pryor BD, Bologna SG, Kahl LE. Risk factors for serious infection during treatment with cyclophosphamide and high-dose corticosteroids for systemic lupus erythematosus. Arthritis Rheum 1996 39(9) 1475-82. 

Old age, renal dysfunction, and concomitant corticosteroid therapy are predisposing risk factors (30,31). Tendon rupture occurred in less than four per million prescriptions (9). 

In a nested case-control study in Mexican patients with rheumatoid arthritis encompassing 1274 patient years, the risk factors were determined for acquiring infectious diseases (378). In addition to the cumulative doses of methotrexate and the duration of corticosteroids use, the mean daily dose of penicillamine was a risk factor. In one patient the infection was secondary to neutropenia. Tests for a possible immunoglobulin deficiency were not performed. 

In the event of NSAID-induced renal failure, the NSAID should be discontinued promptly. The patient should receive supportive care, including temporary dialysis if needed. Beware that after stabilization of renal function, rechallenge with the same or even a structurally different NSAID is likely to reproduce the undesirable side effect. Hence, if anti-inflammatory therapy is essential, underlying risk factors should be identified and eliminated. If this is not possible, as in the case of old age or chronic kidney or liver failure, the patient may require alternative therapy using corticosteroids or other supportive drugs, such as acetaminophen and/or opioids. 

Chronic obstructive pulmonary disease is a respiratory condition characterized by irreversible airway obstruction caused by chronic bronchitis or emphysema. The major symptoms of COPD include chronic cough, increased sputum production, and dyspnea. The vast majority of patients with COPD are those who are current or former heavy smokers. Other risk factors for the development of COPD include occupational exposure (dusts, chemicals) and rare genetic disorders (a -antitrypsin deficiency). The medical management of COPD includes pharmacotherapy (bronchodilators, corticosteroids, and antibiotics) in combination with interventions to reduce risk factors for disease progression (e.g., smoking cessation). Some patients require long-term administration of supplemental oxygen. 

There are several recognized risk factors in the development of keratomycosis, including inappropriate topical antibiosis and protracted topical corticosteroid therapy. Topical corticosteroids are likely to duninish both ceU-mediated immune... 

Many poisons can disturb mental and rational function leading to behavioral abnormalities. Psychototoxins include phencyclidine, LSD, and fungal toxins. Less commonly, stimulants such as cocaine and amphetamine can cause psychiatric problems. Psychiatric effects of high doses of corticosteroids have also been described. In addition to the developmental retardation, some investigators believe that cognitive impairment, hyperactivity, and perhaps even antisocial behavior may be caused by childhood lead exposure. Public discussion of these subtle toxic effects is highly politicized because childhood exposure to lead still occurs as a risk factor in slums and tenements. 

---