systemic corticosteroids (steroids) prednisolone - glucocorticoid

Question 1

Indications of prednisolone?

Answer 1

suppression of inflammatory and allergic disorders - COPD, croup, asthma, idiopathic thrombocytopenic purpura, eczema inflammation, Crohns disease, ulcerative colitis, myasthenia gravis, rheumatoid arthritis, polymyalgia rheumatica, proctitis

Question 2

Contraindications of prednisolone?

Answer 2

systemic infection, avoid live virus vaccines in those receiving immunosuppressive doses, avoid injections containing benzyl alcohol in neonates

Question 3

Mechanism of action of prednisolone?

Answer 3

glucocorticoids are naturally occurring steroid hormones. prednisolone is a natural corticosteroid hormone receptor agonist so enhances their effect and causes some genes to be activated and some to be suppressed, leading to altered levels of proteins made by the cell. this reduces the action of several immune cells (lymphocytes, macrophages, eosinophils), inhibits prostaglandin synthesis and reduces production of immunoglobulins and the release of inflammatory mediators (histamine, cytokines)

Question 4

Common side effects with prednisolone?

Answer 4

mostly psychiatric effects - mood and behavioural changes - irritability, depressed, psychosis, mania, anxiety, insomnia. immunosuppression/infections, weight gain, hunger, heartburn, nausea, dizziness, headache, acne, swollen face

Question 5

Monitoring requirements for prednisolone?

Answer 5

pregnant women with fluid retention should be monitored closely, children on prolonged treatment should have height and weight monitored annually in case of slow growth

Question 6

Treatment cessation for prednisolone?

Answer 6

abrupt withdrawal after prolonged treatment can lead to acute adrenal insufficiency, hypotension or even death. withdrawal can be associated with fever, myalgia, arthralgia, rhinitis, conjunctivitis, painful itchy skin nodules and weight loss. dose reduction should be decided case by case and done gradually in those who are unlikely to relapse

Question 7

Patient and carer advice for prednisolone

Answer 7

patients should carry a steroid treatment card which gives guidance on minimising risk and provides details of prescriber, drug and dosage. all patients should be given an information leaflet and particularly advised on: mood and behavioural changes, adrenal suppression, immunosuppression and other serious effects (musculoskeletal, ophthalmic and gastro-intestinal