Immunomodulators and Antineoplastics

Question 1

Systemic Corticosteroids

Answer 1

C- corticosteroids, regulate gene expression which has glucocorticoid (suppression of inflammation, immunosuppression, gluconeogenesis etc) and mineralocorticoid effects (hypertension, water and sodium retention, potassium loss)

I- various inflammatory and immune mediated conditions- eg suppression of organ transplant rejection, RA, as part of chemotherapy (antiemetic), CAP, adrenal replacement for corticosteroid insufficiency

Cortisone-oral 0.3mg/kg (up to 35mg) daily in 2 or 3 doses (3 doses preferred with half dose in morning, 0.25 at lunch and 0.25 4 hours later before 5pm).

Dexamethasone- 0.5-20mg daily in 2-4 doses (max 40mg daily IV in bacterial meningitis)

Hydrocortisone- 0.24mg/kg (usually 12-25mg) daily in 2 or 3 doses (same splitting as cortisone). IM/IV 100mg stat in addisonian crisis followed by 200mg infused over 24h

Prednisolone/prednisone 5-60mg once daily

M- duration of use, HPA suppression, addisonian crisis/physiological stress, GI ulceration/AE, blood glucose (hyperglycaemia), hypertension, fluid balance, psychiatric state (psychiatric conditions may worsen), intra-ocular pressure, cataracts, glaucoma, infection (immunosuppression), BMD, potassium (hypokalaemia), weight (increased appetite and weight gain), growth in children, sodium (hypernatraemia)

C- take in the morning with food, see dr asap for any signs of infection, may affect your mood and sleep, dont stop suddenly unless directed by dr, tell all HCP you’re taking steroids, consider medic alert bracelet, make sure family and patient know signs of addisonian crisis and when to go to hospital

CALs- 9, B