With corticosteroids

The predominant clinical use of corticosteroids is a result of their associated antiinflammatory properties. These are commonly used as topicals for the suppression of symptoms, including inflammation, occurring in a particular disease state these compounds are rarely considered curative in their usage. Many other disease states do, however, respond well symptomatically to treatment with corticosteroid therapy. Some of these (11) are Hsted below. 

Corticosteroids may be given in high doses for some arthritic disorders. Many adverse reactions are associated with high-dose and long-term corticosteroid therapy. Chapter 50 discusses some of the adverse reactions associated with corticosteroid therapy. A comprehensive list of adverse reactions is provided in Display 50-2. Contraindications, precautions, and interactions of the corticosteroids are discussed in Chapter 50. 

MANAGING FLUID AND ELECTROLYTE IMBALANCES. Fluid and electrolyte imbalances, particularly excess fluid volume, are common with corticosteroid therapy. The nurse checks the patient for visible edema, keeps... 

Interference with corticosteroid function and the stress response has been shown for a variety of chemicals, including the pharmaceutical salicylate (Gravel and Vijayan 2006) and the PAH, phenanthrene (Monteiro et al. 2000a, 2000b). Other classes of chemicals shown to have significant effects on cortisol levels include PCBs and PAHs (Hontela et al. 1992,1997). The precise mechanisms for these effects are poorly understood, but for PCBs, are believed to be via their actions through the Ah receptor (Aluru and Vijayan 2006). 

Spacers/holding chambers are useful for all patients. They are particularly recommended for young children and older adults and for use with corticosteroids. 

Corticosteroids, while effective for rapidly inducing remission, are not effective for maintenance therapy and are associated with significant adverse effects with long-term use. Therefore, systemic or topical corticosteroids should not be used for maintaining remission in patients with IBD. Unfortunately up to 50% of patients treated acutely with corticosteroids become dependent on them to prevent symptoms.2... 

Acute relapses are treated with corticosteroids to speed recovery of the patient. 

Clearly the physicochemical properties of a drug are a decisive factor in its overall activity. Where possible, molecular structures should be optimized to obtain best clinical performance. Rarely does an oral drug have physicochemical features suitable for topical or transdermal therapy, and it can take a great deal of systematic research to identify where the best balance of activity and permeability lies. Experience with corticosteroids suggests that as much as a 100-fold improvement in clinical activity may be attainable through molecular design, for today s most potent topical corticosteroids are more active than hydrocortisone by a factor at least this large. 

Initial therapy frequently consists of an alkylating agent in conjunction with corticosteroids these regimens can be found in the CLL (chlorambucil, cyclophosphamide) and multiple... 

Risk of TB in patients treated with corticosteroids increases with higher dose and longer duration. 

Corticosteroids can produce a variety of devastating and systemic effects. Some of the ADRs associated with corticosteroids are listed in Table 28.4. 

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