Prednisone

Question 1

By what mechanisms does prednisone work?

Answer 1

1. Immunosuppression
2. Anti-inflammatory
3. Impairs wound healing
4. Reduced angiogenesis, vasoconstriction

Question 2

How does prednisone convert to (1) hydrocortisone (2) dexamethasone

Answer 2

1. 4x stronger
2. 7x weaker

Question 3

What are the contraindications to prednisone?

Answer 3

Hypersensitivity
Pregnancy/lactation
Active/recent infection or malignancy
Diabetes mellitus
Hypertension
Congestive cardiac failure
PUD
Psychosis
Osteoporosis
Glaucoma/cataracts

Question 4

What drugs interact with prednisone?

Answer 4

CYP3A4 drugs
NSAIDs
Anticoagulants
Diuretics
Live vaccines

Question 5

What are the adverse effects of prednisone?

Answer 5

Skin
- poor wound healing, atrophy, striae, telangiectasia, bruising, ulcers, steroid acne/rosacea, perioroficial dermatitis, telogen effluvium
Endocrine
- Cushingoid changes, menstrual irregularity, increased appetite, weight gain, hyperglycaemia, hypertension, hyperlipidemia
Eyes: cataracts, glaucoma
GI: reflux, fatty liver, bowel perforation
Bone: growth impairment, myalgia/myopathy, osteoporosis/necrosis
CVS: CCF, hypokalemia
CNS: insomnia, agitation, depression, psychosis, BIH, peripheral neuropathy
Infection: staph, HSV skin infection, TB reactivation, opportunistic infections
Malignancy: KS

IM specific: cold abscess, lipoatrophy, crystallisation

Question 6

What is the evidence around the use of prednisone in pregancy?

Answer 6

Animal studies show cleft lip/palate
Human studies - no increased risk of malformations

Question 7

What baseline testing/screening is needed for prednisone?

Answer 7

Hx
psychosis, cataracts/glaucoma
DM, HTN, hypercholesterolemia, CVD
Reflux, diverticulosis, recent bowel surgery
Osteoporosis
Planned surgery

Exam
height/weight/BMI, BP
lymph nodes
Active infection

Laboratory
FBC, UEC, LFT, BSL/HbA1c, lipid profile
Immunosuppression screen
DEXA, ophthalmology review

Question 8

What prophylaxis should be considered when prescribing prednisone 20mg daily or more for 4 or more weeks?

Answer 8

Lifestyle advice: exercise, healthy balanced diet, reduce alcohol consumption, smoking cessation, weight loss

Calcium/vitamin D supplementation
PPI
PJP prophylaxis eg Bactrim m/w/f or dapsone
Stress dosing for surgery or severe illness

Question 9

What monitoring is required for prednisone?

Answer 9

Side effects / compliance
Height, weight, BMI, Blood pressure

FBC, UEC, LFT, CMP, BSL/HbA1c, lipid profile

Ensure on calcium/Vit D, PPI
DEXA 2 yearly
Opthal annually
Endocrine advice near cessation