Steroids prednisone

The current induction therapy for acute lymphocytic leukemia (ALL) typically consists of vincristine, asparaginase, and a steroid (prednisone or dexamethasone). An anthracycline is added for higher-risk patients. 

The answer is a. (Hardman, p 1302.) Cyclophosphamide, an alkylating agent, reacts with purine and pyrimidine bases of DNA to form bridges and dimers. These products interfere with DNA replication. 5-FU, methotrexate, and 6-thioguanine are anti metabolites, and the steroid prednisone has some tumor-suppressive effects. 

Short-term use of glucocorticoids, even in massive dosages, is less likely to produce harmful reactions. They can, however, produce a variety of effects that are neither limited to high doses nor to long-term therapy. When a low dose of steroids (prednisone) was given for several months to a 38-year-old man to treat eczema of his hands and feet, he developed bilateral avascular necrosis (AVN) of the femur. He therefore had total bilateral hip replacement, and several experts have attributed his AVN to the steroid administration. The man sued his allergist, who settled the lawsuit shortly before trial for approximately 400,000. Most practitioners, however, are unaware of the risk of short-term or low-dose steroids. Yet many of these cases can be found in the courts, the literature, and the MedWatch databases. 

We have already noted the effects of glucocorticoids that block AA release by inhibition of phospholipases. These include cortisol and certain synthetic steroids (prednisone and dexamethasone), which have antiinflammatory actions. 

The correct answer is B. Due to the increased severity of this allergic reaction secondary to re-exposure, the next step in therapy is oral steroids. Prednisone, a glucocorticoid, is commonly used to treat conditions such as skin inflammation, asthma, and arthritis. Prednisone acts by decreasing the production of the mediators of inflammation, thereby resulting in its antiinflammatory action. A is incorrect. Hydrocortisone is a low potency glucocorticoid that is indicated for mild inflammation and irritation of the skin. The child s inflammation is severe enough to require systemic steroid therapy. 

Lid eczema may be treated with steroid ointments or creams, such as hydrocortisone 1%, and, in severe cases, with systemic steroids (prednisone).Topical steroids may be required to prevent corneal and conjunctival scarring. 

The client with poison ivy is prescribed a dose pack of the steroid prednisone. Which statement best describes the scientific rationale for prescribing the dose pack ... 

Snyder and co-workers [606] studied the retention of benzyl alcohol, m-nitroacetophenone, 10 substituted naphthalenes, chrysene, and perylene on a 30°C diol column using a series of isocratic dichloromethane/hexane (0/100 to 35/65) mobile phases. Retention results for all compounds at various isocratic mobile phase compositions are tabulated. Five steroids (prednisone, corticosterone, adrenosterone, 4-androstene-17a-ol-3-one, and 4-androstene-17j5-ol-3-one) were similarly studied but at ranges of dichloromethane from 13% to 80%. Also presented in this work is an equation from which the eluotropic strength of an A -F B solvent mixture, i.e.. 

Oral steroids (prednisone tapers or dose packs) or Intramuscular steroids (kenalog 40 mg IM) or Intralesional triamcinolone, gradually increasing the concentration up from 3 mg/oc, injected monthly until resolved... 

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. 

Aerosolized steroids clearly play an important role in the present-day management of asthma (87). They are reasonably safe and work best when taken prophylacticaHy. Patient compliance, however, remains a significant problem. In part this problem is typical of any aerosolized agent. But in the case of steroids, the problem is exacerbated because a patient needs to take the steroids (especially prednisone) are the antiasthmatic agents of last resort and are widely used to treat status asthmaticus. An agent that could mimic the actions of steroids but which would work faster and/or without side effects might be the ideal antiasthmatic agent. 

An unusual reaction was been observed in the reaction of old yellow enzyme with a,(3-unsat-urated ketones. A dismutation took place under aerobic or anaerobic conditions, with the formation from cyclohex-l-keto-2-ene of the corresponding phenol and cyclohexanone, and an analogous reaction from representative cyclodec-3-keto-4-enes—putatively by hydride-ion transfer (Vaz et al. 1995). Reduction of the double bond in a,p-unsaturated ketones has been observed, and the enone reductases from Saccharomyces cerevisiae have been purified and characterized. They are able to carry out reduction of the C=C bonds in aliphatic aldehydes and ketones, and ring double bonds in cyclohexenones (Wanner and Tressel 1998). Reductions of steroid l,4-diene-3-ones can be mediated by the related old yellow enzyme and pentaerythritol tetranitrate reductase, for example, androsta-A -3,17-dione to androsta-A -3,17-dione (Vaz etal. 1995) and prednisone to pregna-A -17a, 20-diol-3,ll,20-trione (Barna et al. 2001) respectively. 

Electron impact ionization, also known as particle beam ionization, has been applied to the online determination of steroids such as hydrocortisone, cortisone, prednisolone and prednisone. Polymer additives such as NC-4, Irga-nox 1076,1-octadecanol and Naugard -XL were identified and quantitated online by electron impact and, separately, by atmospheric pressure chemical ionization methods.78... 

Oral corticosteroids may be used for patients who are unresponsive to sulfasalazine or mesalamine. Prednisone doses of 40 to 60 mg per day (or equivalent) are recommended.1 Azathioprine or 6-MP is used for patients unresponsive to corticosteroids or those who become steroid-dependent. Over a 12-month period, these agents have been shown to reduce the relapse rate to 36% versus 59% seen with placebo.1 Infliximab 5 mg/kg may also be used for patients who are unresponsive to conventional oral therapies and may reduce the need for colectomy after 3 months of treatment.35... 

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 ... 

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. 

Steroids have a place in the treatment of moderate to severe ulcerative colitis that is unresponsive to maximal doses of oral and topical mesalamine. Prednisone up to 1 mg/kg/day or 40 to 60 mg daily may be used for patients who do not have an adequate response to sulfasalazine or mesalamine. 

The use of glucocorticoids for tuberculous meningitis remains controversial. The administration of steroids such as oral prednisone, 60 to 80 mg/ day (1 to 2 mg/kg/day in children), or 0.2 mg/kg/day of IV dexametha-sone, tapered over 4 to 8 weeks, improves neurologic sequelae and survival in adults and decrease mortality, long-term neurologic complications, and permanent sequelae in children. 

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. 

Steroid psychosis Steroid psychosis is characterized by a delirious or toxic psychosis with clouded sensorium. Other symptoms may include euphoria, insomnia, mood swings, personality changes, and severe depression. The onset of symptoms usually occurs within 15 to 30 days. Predisposing factors include doses greater than prednisone 40 mg equivalent, female predominance, and, possibly, a family history of psychiatric illness. 

Stabilize the patient s asthma before treatment is started. Initially, use aerosol concurrently with usual maintenance dose of systemic steroid. After approximately 1 week, start gradual withdrawal of the systemic steroid by reducing the daily or alternate daily dose. Make the next reduction after 1 to 2 weeks, depending on response. Generally, these decrements should not exceed 25% of the prednisone dose or its equivalent. A slow rate of withdrawal cannot be overemphasized. 

Corticosteroids suppress proliferation of lymphocytic cells, thus they are useful at combating acute lymphoblastic or undifferentiated leukemia of childhood, chronic lymphocytic leukemia, Hodgkin s lymphoma, other lymphomas. Therapy is often initiated with a steroid in combination with other agents. There is no evidence of cross resistance to unrelated agents. Mostly prednison is used however at appropriate dosages similar effects can be obtained with other glucocorticosteroids. 

Minimal-change disease is more common in children than in adults. It is rare in black children and adults of sub-Saharan Africa. Minimal-change responds well to steroids. However, it may recur after prednisone is decreased or discontinued. In such cases, the addition of cyclophosphamide or chlorambucil may produce a response. The GFR is normal. Progression to renal failure does not occur unless focal glomerulosclerosis is present. 

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