a health care professional is caring for an older patient who is about to begin taking prednisone This is a topic that many people are looking for. passionistsisters.org is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, passionistsisters.org would like to introduce to you Prednisone. Following along are instructions in the video below:
Im dr. Ken linda thanks for watching lets talk about prednisone prednisone is is a courtesan like steroid. Its synthetic.
Its an anti inflammatory glucocorticoid that patented in 1954 approved by the food and drug administration in 1955. And even though. Its more than 60 years old it still ranks in the top 25 prescription medicines here in the united states with 22 million prescriptions written each year and as a matter of fact.
Its on an upward trend. And its almost identical twin prednisolone well there are more than 5 million. Prescriptions written every year for it.
And it also is on an upward trend. Now prednisone is a treatment for almost whatever ails. You its four endocrine disorders and rheumatic disorders.
Connective tissue disorders and skin rashes and allergic reactions. Its good for eye disease and respiratory disease and blood related diseases and cancers and gastrointestinal conditions. And its used as an anti inflammatory drug and in some cases.
It actually can counteract adem. Even though it may cause edema. So lets take a little closer look at some of the uses of this very important medicine.
Its used for skin disease. So in a falasca and logic reactions. Angioedema serum sickness.
Its used for exfoliant of dermatitis. Where the skin. Often very severe eczema and contact allergies and insect bites and drug reactions.
Its used. When your calcium is elevated. Because you have metastatic disease to the bone or from sarcoidosis or the calcium can be up.
Because you take too much vitamin d. Its good for connective tissue diseases like rheumatoid arthritis and psoriatic arthritis and post traumatic. Osteoarthritis and acute tenosynovitis.
When you cant lift your shoulder. Its used for acute gouty arthritis and lupus and vasculitis. Its used for dermatomyositis polymyositis.
Its used for five conditions. So its used when people have a thyroid condition and start developing some fluid around the eye or subacute thyroiditis. Where a person has fever and thyroid pain and swelling.
Its used for a condition known as congenital adrenal hyperplasia. Its used for certain eye diseases. So it can decrease the scarring from ocular injuries like shingles or in people.
With optic neuritis or multiple sclerosis or people and people who have significant ocular allergies. Although for many cases topical steroids will do oftentimes. We need to resort to oral prednisone.
Its used for neoplastic diseases for leukemia and for lymphoma for unresponsive breast cancer in myeloma. Its used for treatment of advanced painful hormone resistant prostate cancer. Its used for liver diseases non alcoholic cirrhosis and women to increase their survival and for chronic active hepatitis.
Its used in neurologic problems. So its used for cerebral edema thats associated with either a primary or metastatic cancer. Use for brain tumors brain injury head injury craniotomy.
Multiple sclerosis as i mentioned before for the acute exacerbations and myasthenia gravis and for organ transplantation to prevent rejection and people who have a parasite known as trichinosis well sometimes it gets into either the heart or the brain for people who have that prednisone seems to be very good for nephrotic syndrome to protect the kidney used for pulmonary disorders. Chronic obstructive pulmonary disease. When you have an exacerbation or aspiration pneumonia or severe asthma or hypersensitivity pneumonitis.
Or you can get a condition. Known as sarcoidosis involving the lungs and even people who have fulminating and disseminated tuberculosis. Well if theyre on therapy to kill the organism.
Then sometimes the steroids can be life. Saving and for people who have aids they can develop a lung infection with parasite known as pneumocystis djurovic ii used to be pneumocystis carini. I well it seems to be quite helpful for that as long as people are on the appropriate anti infective therapy.
And its good for blood disorders. Like a quieter autoimmune hemolytic. Anemia or when your platelets go very low.
Thrombocytopenia or in people who have blood breakdown right in the system. Well. Its also good for decompensated heart failure in some people to increase the renal response to the diuretics youre taking so overall the use of prednisone is extraordinarily important in medicine.
It suppresses the immune system. It decreases inflammation treats high calcium treats adrenal insufficiency. Along with other kind of steroids mechanism of action is relatively simple it attaches to the surface receptors gets inside the cell goes into the nucleus binds to certain nuclear receptors and then that involves the genes and it activates or inactivate certain genes.
It also counteracts histamine that increases the red blood cells in the bone marrow increases the survival of the red blood cells and the platelets it reduces the allergy cells those eosinophils it promotes the production of glucose alters. The distribution of fat from the periphery of the body to the center. Part of the body increases.
The protein breakdown decreases. The intestinal absorption and increases. The kidneys excretion of calcium works to prevent some of the immune complexes from blocking up.
The kidneys increases. Cell differentiation stimulates. The cell death in cancer cells can stimulate fat synthesis.
Fat storage that acts to counteract the activity of insulin. So that means you tend not to use too much glucose. But the glucose that you do have seems to accumulate in the bloodstream in the liver.
Its antiemetic so it can help reduce vomiting well anything that has so many positive effects also has some negative effects and the negative effects are extraordinarily long. So lets go over some of them the minor effects can make you nervous or lead to acne or increase your appetite and that increases your weight increases hyperactivity seems to lead leg pain leg cramps. And some individuals headaches and stretch marks leads to indigestion.
If you take it too long it can predispose to cataracts and bone loss osteoporosis easy bruising on your arms and legs can lead to muscle weakness and yeast overgrowing in the throat can lead to increased blood glucose. Which leads to diabetes increases. The likelihood that youre going to develop an infection and also seems to cause some psychiatric reactions causes agitation and euphoria along with depression and anxiety well the more major complications are steroid atrophy or steroid myopathy leads to mania can lead to unusual fatigue and weakness mental confusion can lead to attention dysfunctional ii caught steroid dementia.
The third vision and of course. The steroid induced osteoporosis is a major problem. But it also can lead to a vascular necrosis breakdown of the bone and death of certain areas of the bone lead to severe joint pain gastrointestinal perforation thats marked so you dont even realize it relatively early on so it can get to be a major problem it can lead to fat deposition.
In the liver can lead to an irregular heart rate can lead to aggression and agitation unusual thoughts shortness of breath that can lead to irregularity of breathing and numbness and tingling in the arms. It can predispose to infection so it can unfortunately cause local infections to disseminate thats a problem. If you have latent infections with candidate.
Our closest or pneumocystis or toxoplasmosis or me even amoeba and if youve been down south or been to the tropics and you have a roundworm infection. A nematode that might be totally asymptomatic and typically is totally asymptomatic sterile strongyloides. Stare.
Corrales well that unfortunately can disseminate and thats a major problem and it can mask the signs of infection. So you could have a viral infection bacterial infection fungal infection. Protozoa infection and you might not have any symptoms.
Well if you have measles or if you have chickenpox and take steroids that can lead to major problems or if you have a ma biases. So youve just come back from the tropics or somewhere. You gotta make sure that you dont take steroids same thing.
If you happen to develop cerebral malaria. Theres a problem if youre taking the prednisone. You shouldnt receive any live vaccines that can be a potential problem.
But the acip thats the committee that provides guidance to federal government on immunization practices as well its okay if youre on the steroids. But you havent been on them for terribly long just less than two weeks or if youre taking a low to a moderate dose or youre taking them on alternate days. Rather than every single day or youre taking a low dose like a maintenance physiological dose five or ten milligrams.
Theres no problem of course if youre using the topical. Steroids or if you have an injection of steroids into a joint have to be careful a little bit about some of the musculoskeletal problems that come along with steroids especially in high dose specially for long periods of time. Because it causes muscle.
Wasting. Typically it causes that in the first six months of therapy. Delays.
The wound healing of course leads to osteoporosis. We talked about more the trabecular bone and cortical bone lead to vertebral compression fractures. Pathologic.
Fractures and long bone. Not uncommon especially serious problem in older individuals injury. People postmenopausal women can lead to tendon rupture of the achilles tendon especially especially when using high doses for a significant period of time lead to fluid and electrolyte problems.
So we have problem with sodium retention that can lead to a demon congestive heart failure and people who are predisposed body loses some potassium you lose calcium because you retain the sodium can increase your blood pressure my diseases lead to cataracts specifically the posterior sub capsular and the nuclear cataracts can increase. The intraocular pressure and lead to glaucoma and damage to the optic nerve and ruin your vision can lead infections inside the eye viral infections. Fungal infections.
Certainly you should not use prednisone. If you happen to have acute her p simplex of your eye can lead to anemia and menstrual abnormalities that can decrease or increase. The sperm motility and number it can increase the blood sugar and worsen your diabetes have to be careful.
If youve had a heart attack recently because it interferes with the normal healing process and can lead to likelihood of increase in the rupture of the heart itself also lead to high blood pressure and pulmonary edema and thrombophlebitis can lead to arrhythmias and congestive heart failure. Certainly. People who are taking steroids have to be a little bit careful at least as far as their mental state is concerned because of euphoria and mood swings and personality changes can lead to depression and psychosis lead to insomnia well there are certain warnings.
So if you have diverticulitis you probably shouldnt take the drug. If you have ulcerative colitis might be an appropriate drug. However if you have impending perforation.
If you have toxic megacolon. This is not the drug for you if you have abscess or if you have infection in the intestine again not the appropriate drug and it can. But the signs of peritonitis especially in older individuals can lead to muscle wasting and problems with wound healing.
Well the prednisone that you take actually is going to down regulate the production of the cortisone from your adrenal gland under normal circumstances. The hypothalamus in the brain. Tells the pituitary to release some chemical to tell the adrenal gland to make the appropriate amount of glucocorticoids in the mineralocorticoids two different kind of cortical well when you take the prednisone.
It turns the whole system off and because it turns the whole system off then your body ultimately after a period of about seven days or thereabout starts to develop whats known as adrenal suppression and the adrenal gland eventually turns itself off so that youre totally independent. If youve been taking the prednisone for a long enough period of time at a high enough dose. The adrenal gland in effect as far as the cortisone is concerned shuts down.
So even if youve been taking the steroids for as little as seven to ten days you probably ought to taper the drug rather than discontinue. It abruptly. So you taper it for a few days.
If your own short term reaction. But if youre on long term dose. You might have to taper it over a period of months or even a year or so because if you abruptly discontinue the drug.
You might lead to a condition that we call an a dasoni in crisis. And that obviously can be quite severe. So you find that the suppression starts at a dose of about seven to ten milligrams.
After a period of about several weeks short term. You can stop abruptly as i mentioned long term. No if you do that youre in trouble.
So you consider well the disease that youre being treated for the likelihood of relapse of the disease. The duration of the treatment and you remember that you want a taper relatively slowly. So we start off at whatever dose.
And you go down by about two and a half maybe five milligrams. A we at five milligrams a day every three to six weeks. So maybe about once a month you decrease the dose right just a little bit until you get to around 7.
And a half milligrams. Then some people say well lets switch over to hydrocortisone itself. That stopped the prednisone go to hydrocortisone and then taper that down slowly or some people just continued gradually gradually over a long period of time decreasing.
The prednisone either one is acceptable if you stop the medicine. Then you might have some withdrawal syndromes. What thrala syndrome could be some lethargy or some fever.
Some muscular pain. Also know that you could develop some adrenal cortical. Insufficiency and that can be a major problem.
Especially if you have some other kind of event that causes your body to need more steering. So if you have the stress of drinking too much alcohol or surgery or trauma or have a heart attack or get dehydrated or you overexert yourself or youre exposed to excessive cold for too long a time period or you have a burn then unfortunately you develop this abba sounion crisis. Where you dont have enough cortisone.
Because your adrenal gland. Even though it might have gotten back to normal after the taper. Its still not back to normal for a period of about six to twelve months after you stop prolong course of steroids and then when you have the stress your potassium can go up your calcium can go up your sodium goes down your blood sugar goes down your blood pressure goes down.
You get dehydrated. You can start to faint. Also people suffer from nausea and vomiting and confusion and lethargy and delirium and headache and sluggishness and a whole series of other conditions.
So you have to treat prednisone with due respect. Its a very important drug. Its a very good drug.
But it has to be handled appropriately you want to take the lowest dose. You possibly can now there are some conditions that require high doses and in those conditions. Well you just have appropriate caution.
You know on therapy monitor people get some tests and get off it as quick as you can it was first described in 1950 by arthur noble. It was first commercially synthesized in 1955 by shearing corporation. Now its part of merck corporation and we know that prednisone is a synthetic adrenal steroid it seems that we need to monitor people who are taking the drug need to check their electrocardiogram their blood pressure get a chest x.
Ray check. The bone mineral density every six months to a year. This vine should do a spine x.
Ray. Check. The fasting blood.
Sugar. And the electrolytes specially the sodium and the potassium check. The persons weight check the stool for blood loss in the pediatric population check the linear growth.
Because the drug can slow growth down check. A morning cortisol. A fasting cortisol pregnancy and breastfeeding seems to be relatively safe.
There can be some problems of course. And first trimester might lead to some or a facial cleft in cleft. Lip.
Cleft palate. The intrauterine growth retardation might occur decrease birth weight breast milk. Its present at about five to 25 of the maternal concentration.
But the total dose that the child gets newborn gets would only be about a tenth of a percent of what the mothers dose is can lead to some decrease in growth and interfere with the endogenous production of the childs steroid. Thats a potential pediatric population. We dont like to use the medicine.
When its not appropriate. But when it is appropriate. Its okay.
But realize that in the pediatric population. It can blunt the growth and maturation lead to osteoporosis and fracture. So its best to give children every other day dose rather than everyday dose.
When you take the prednisone. Its going to require some kind of metabolite. Some turn require metabolism because prednisone itself is inactive.
Its got to be converted the inside the body through some enzymes into prednisolone thats the active form that goes and binds to the cell and activates the receptors gi absorption peak absorption if you take it with food if you take it with some food its less likely to cause gastrointestinal upset. However its interesting to note that theres a decrease in absorption. If you take it on an empty stomach the half life of the medicine.
Its 2 to 4 hours and children. Its only about 1 to 2 hours. Its inactivated by those drug metabolizing enzymes.
Weve talked about before the three a four and it seems that medicines that inhibit the production of 3a4 going to increase the concentration of prednisone in the body on the other hand. If you take a drug that is going to stimulate or induce that 3a4 then your prednisone is going to be more rapidly metabolized wont have as much of it in the body. Well theres some interaction.
So if you take it with non steroidal anti inflammatory drugs and a person motrin. Even just the aspirin might lead to increased gastrointestinal upset to take it with cyclosporine because you have an organ transplant. Well it can increase the concentration of both the prednisone and the cyclosporine.
If your hypothyroid. The concentration is going to build up in the system hyperthyroid people going to have less of the prednisone in the system. Its unpredictable in its response to the oral anticoagulants.
If you take a birth control pill. Its going to increase the concentration of prednisone and if you take a diuretic. Its going to decrease the amount of potassium in the system.
And they both are going to do the same thing. We have a natural cycle of production of your own endogenous cortisone and the cortisone you make is not exactly the same thing as the prednisone that you take so it seems that the maximal adrenal cortical activity is between about 6 00. In the morning and the absolute peak is around eight to nine oclock in the.
Morning and you have a minimal production sometime between. About 9 00. Pm and 3 00 am with around midnight being the lowest level of cortisone in your body.
Well. How do you take the drug. Some diseases require you take the drug bailey.
But if youre going to take it on a long term basis and if its appropriate for whatever disease you happen to be taking it for well it seems that if you double the dose and take it every other day rather than every day. Thats going to reduce the likelihood of the adrenal suppression. And its going to reduce the damage to your muscles.
So thats pretty good reason to do the every other day dose prednisone comes in a lot of different forms comes in a tablet or a solution or a suppository comes in a delayed release tablet. The only difference about the delayed release tablet is you take it now and four hours later it starts to work rather than it starts to work. As soon as you take it pay a significant price for that four hour delay.
It also comes as a nasal spray it comes intravenously individualized the dose could be anywhere from one or two or five milligrams could be up to sixty or more milligrams. Again depends on the particular dose tend to come off it relatively slowly. Thats why most people are aware of the dose packets different kind of cortisone.
But the dose pack will you take seven pills and six bills on five minute four and three and two and one well you can do the same thing with prednisone you can take say six or seven or eight or ten today and then you cut down each subsequent day. Thats quite acceptable the drug is very inexpensive. So you can buy thirty of the five milligram tablets for anywhere between about ten dollars and thirty dollars with the coupon from good rx you get it for less than ten dollars.
Now they do make that delayed release form and the delayed release form you can buy thirty of the five milligram tablets not for less than ten dollars. But the list price the cash price the cash price go to the pharmacy is going to be 3200 per. Month and if you have a discount coupon get it for 2700 per month.
Now its made by horizon pharmaceuticals. They also make another chemical known as do axis two xs combines ibuprofen you get that without a prescription over at the grocery store. And it has a little bit of pepsin thrown in it both of those are very inexpensive.
But when horizon pharmaceuticals puts. It together as two xs their cash. Price if you go to the drugstore is about 2900.
And with their coupon. Its twenty five hundred dollars. So thats the story about prednisone.
Its as close to a miracle pill as you can get it has lots of uses in medicine. But it has just as many adverse reactions to it especially if its used for long periods of time at high doses or if its used inappropriately so. When you use it appropriately use it for the shortest period of time possible at the lowest dose possible and if you do that then hopefully youll come through your course of therapy.
Much to the better and you escape a lot of the side effects anyway. Thanks for watching if you enjoyed the show. Please tell a friend consider subscribing.
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