Pulse therapy with

Empty sella syndrome occurred in a boy who developed hypopituitarism after long-term pulse therapy with prednisone for nephrotic syndrome (107). 

Among the adverse effects of pulse glucocorticoid therapy, joint manifestations are rare. A woman with systemic lupus erythematosus and nephritis developed transient bilateral knee effusions during pulse therapy with high doses of glucocorticoids (279). 

During ongoing therapy with the antiarrhythmic dragp, the nurse takes the patient s blood pressure apical and radial pulses, and respiratory rate at periodic intervals, usually every 1 to 4 hours. Specific intervals depend on... 

A transient increase in arrhythmias and hypertension may occur within 1 hour after initial therapy with bretylium is begun. The nurse should take the blood pressure and respiratory rate every 5 to 15 minutes and obtain the pulse rate from the cardiac monitor. These activities are continued until the arrhythmia is corrected. 

Self-Monitoring Pulse Rate With Anti arrhythmic Therapy... 

When markedly impaired growth is noted in patients treated with glucocorticoids long-term or in pulses, it is necessary to assess pituitary function and the anatomy of the pituitary gland. Children who receive glucocorticoid pulse therapy may develop an empty sella more frequently than is usually recognized. 

Glucocorticoids should be used with caution in progressive systemic sclerosis, and concomitant administration of anticoagulants to prevent ischemic colitis is recommended when administering glucocorticoids in high doses, especially by pulse therapy (SEDA-21, 415 150). 

There has been a report of seven cases of acute severe liver damage associated with intravenous glucocorticoid pulse therapy in patients with Grave s ophthalmopathy (159). 

No adverse effects are to be expected after a single injection of a high dose of a glucocorticoid, but some serious complications have been observed with repeated use, including both infections and the known direct adverse effects of glucocorticoids. Cases of ventricular dysrhythmias and atrial fibrillation have been reported (SEDA-18, 391). With pulse therapy, the nature of the injected glucocorticoid seems to be important for example, hydrocortisone, which is more rapidly metabolized, seems to be better tolerated than dexamethasone (SEDA-6, 331). 

Kobayashi S, Warabi H, Hashimoto H. Hypopituitarism with empty sella after steroid pulse therapy. J Rheumatol 1997 24(l) 236-8. 

Weissel M, Hauff W. Fatal liver failure after high-dose glucocorticoid pulse therapy in a patient with severe thyroid eye disease. Thyroid 2000 10(6) 521. 

The respiratory and cardiovascular adverse effects of topical therapy with timolol or betaxolol have been studied in a randomized, controlled trial in 40 elderly patients with glaucoma (83). Five of the 20 allocated to timolol discontinued treatment for respiratory reasons, compared with three of the 20 patients allocated to betaxolol There were no significant differences in mean values of spirometry, pulse, or blood pressure between the groups. This study confirms that beta-blockers administered as eye-drops can reach the systemic circulation and that serious adverse respiratory events can occur in elderly people, even if they are screened before treatment for cardiac and respiratory disease. These events can occur using either the selective betaxolol agent or the non-selective timolol. 

Glucocorticoids inhibit the formation of antibodies. Of 111 consecutive heart transplant recipients taking oral prednisone (mean 13.8 months), 57% developed hypogammaglobulinemia (IgG below 7 g/1) (266). Those with severe hypogammaglobulinemia (IgG below 3.5 g/1) were at increassed risk of opportunistic infections compared with those with IgG concentrations over 3.5 g/1 (55 versus 5%, OR = 23). Parenteral glucocorticoid pulse therapy... 

Illei GG, Austin HA, Crane M, et al. Combination therapy with pulse cyclophosphamide plus pulse methylprednisolone improves long-term renal outcome without adding toxicity in patients with lupus nephritis. Ann Intern Med. 2001 135 248-257. 

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