systemic corticosteroids- prednisolone Flashcards
Discuss a glucocorticoid
Lipid soluble, can cross the plasma membrane. Once they have entered the cells they bind to glucocorticoid receptors in the cytoplasm. The receptor-hormone complex then moves into the nucleus where it binds to specific genes. This binary causes some genes to be activated and some to be supressed. This in turn alters levels of proteins made by the cell. The main effect of glucocorticosteroids is that it is a metabolic and anti-inflammatory/ immunosupressant.
What is the mechanism of action for prednisolone?
Prednisolone is a corticosteroid with mainly glucocorticoid activity. Inhibits leukocyte infiltration at the site of inflammation, interferes with mediators of inflammatory response and supresses humoral immune responses. Anti inflammatory actions of glucocorticoids are thought to involve phospholipase A2 inhibitory proteins and lipocortins, which control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes. Prednisolone reduces inflammatory action by limiting the capillary dilation and permeability of the vascular structures. These compounds restrict the accumulation of polymorphonuclear leukocytes and macrophages and reduce the release of vasoactive kinins. Recent research suggests that corticosteroids may inhibit the release of arachidonic acid from the phospholipids, thereby reducing the formation of prostaglandins. Prednisolone is a glucocorticoid receptor agonist. On binding the cortico-receptor ligand complex transloactes itself into the cell nucleus, where it binds to many glucocorticoid response elements (GRE) in the promoter region of the target genes. The DNA bound receptor then interacts with basic transcription factors, causing an increase or decrease in expression of specific target genes, including the supression of K2 (interleukin 2) expression.
side effects of prednisolone?
indigestion, weight gain, insomnia, restlessness, increased sweating, headaches, nausea.
indication of prednisolone?
exacerbation of COPD, asthma, severe/ mild croup, suppression of inflammatory and allergic disorders.
monitoring requirements of prednisolone?
patient parameters. In children receiving prolonged treatment- annual height and weight. If growth is slowed, refer to pediatrician.
What are the contra-indications of Prednisolone?
NICE (2015) guidelines: oral corticosteroids - in people with systemic infections. Can mask symptoms of infection. Avoid live virus vaccines in those receiving immunosupressant doses (serum anti body response diminished).
What advice should you give to patients/ carers about prednisolone?
steroid treatment card which gives guidance on minimising risk and provides details of prescriber, drug, dose and duration of treatment.
Patients should be advised on the following:
1) immunosupression- prolonged courses can increase susceptibility to infection and it can go unrecognised, unless already immune. Should avoid people with chicken pox if not already immune, as could be severe
2) mood and behaviour changes: confused, irritable, delusions,
3) serious side effects: GI, muscoskeletal & ophathlamic effects that require medical attention may occur.
