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The federal Omnibus Budget Reconciliation Act regulates medication use in residents of long-term care facilities. According to the OBRA guidelines, the need for continued use of a glucocorticoid, with the exception of topical, ophthalmic, or inhaled formulations, should be documented, along with monitoring for and management of adverse consequences. Intermediate or longer-term use may cause hyperglycemia, psychosis, edema, insomnia, hypertension, osteoporosis, mood lability, or depression. Prednisolone should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Based on findings from human and animal studies, corticosteroids can cause fetal harm when administered to a pregnant woman. Published epidemiological studies suggest a small but inconsistent increased risk of orofacial clefts with the systemic use of corticosteroids during the first trimester.
For children from the age of birth to adulthood, Pediatric care encompasses a broad spectrum of health care services and the pediatric dose calculator provides us with more accurate dosage calculations. Young’s rule’s for the pediatric dosage are normally based on age and approximate body weight of the child during the first year of adolescence. This is the main reason Young’s Rules is not only considered to find the dosage for pediatrics but also for adults. After picking up the prednisolone from the pharmacy, the mother gives her child the prescribed dose of 5 mL. Almost instantaneously, the child spits out the medicine because of its bitter taste.
Practice guidelines for the management of asthma in children universally recommend systemic corticosteroids for the treatment of moderate to severe asthma exacerbations. However, these guidelines vary widely with respect to dose, frequency, method of delivery, and duration of therapy. In actual practice, there is also considerable variation among clinicians in terms of corticosteroid dosing in children hospitalized with asthma exacerbations.
Those that meet enrollment criteria will be randomized to receive prednisolone either in the higher dose (1.0 mg/kg every 6 hours), or the lower dose (1.0 mg/kg every 12 hours and placebo doses at 6 hour intervals in between) for the first 48 hours of hospitalization. Once 48 hours has past, all patients still hospitalized will receive 1.0 mg/kg every 12 hours for the duration of hospitalization. Approximately 156 patients with 78 in each arm of the study will be enrolled. The primary outcome will be duration of hospitalization, as determined by duration of time elapsed from first dose of prednisolone administered in the emergency department until the discharge dose of albuterol is administered. Systemic corticosteroids, such as prednisolone, may decrease glucose tolerance, produce hyperglycemia, and aggravate or precipitate diabetes mellitus. When corticosteroid therapy is necessary for patients with diabetes mellitus, changes in insulin, oral antidiabetic agent dosage, and/or diet may be required.
Use prednisolone with caution in patients with a seizure disorder; systemic steroids can lower the seizure threshold. Reduce dose to 1 to 2 drops in each eye twice daily after 1 to 2 weeks if positive response in signs and/or symptoms and start cyclosporine, then taper or discontinue steroid therapy after 2 to 4 weeks. Consider extending duration to 4 weeks if no response at 2 weeks, especially in patients with moderate to severe disease.
Reserve systemic corticosteroid therapy in active tuberculosis for patients with fulminating or disseminated disease and only in conjunction with appropriate antituberculosis therapy. Reactivation of tuberculosis may occur in patients with latent tuberculosis or tuberculin reactivity; close observation for disease reactivation is needed if corticosteroids are indicated in such patients. Furthermore, chemoprophylaxis is advised if prolonged corticosteroid therapy is needed. Advise patients receiving immunosuppressive doses of systemic corticosteroids to avoid exposure to persons with a viral infection (i.e., measles or varicella) because these diseases may be more serious or even fatal in immunosuppressed patients. If exposed to chickenpox, prophylaxis with varicella-zoster immune globulin may be indicated.
Intrauterine growth restriction and decreased birth weight have also been reported with maternal use of corticosteroids during pregnancy; however, the underlying maternal condition may also contribute to these risks. Published animal studies show prednisolone to be teratogenic in rats, rabbits, hamsters, and mice with an increased incidence of cleft palate in offspring. Advise a pregnant woman about the reproductive risk and the potential harm to a fetus. Neonates born to pregnant women who have received corticosteroids should be carefully monitored for signs and symptoms of hypoadrenalism, and appropriate therapy should be initiated, if necessary. Ophthalmic prednisolone and other ocular corticosteroids were applied to both eyes of pregnant mice ; a significant increase in the incidence of cleft palate was observed in the fetuses of the treated mice. Corticosteroids decrease bone formation and increase bone resorption both through their effect on calcium regulation (i.e., decreasing absorption and increasing excretion) and inhibition of osteoblast function.
2 mg/kg/day PO in 3 divided doses until CRP is normalized, then taper over 2 to 3 weeks. In patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during, and after the stressful situation is indicated. Corticosteroids may mask some signs of infection, and new infections may appear during their use. There may be decreased resistance and inability to localize infection when corticosteroids are used.
Instruct patients to avoid wearing soft contact lenses prior to the application of prednisolone acetate ophthalmic suspensions. The suspensions contain benzalkonium chloride, which may be absorbed by soft contact lenses; the lenses may be reinserted 15 minutes following its administration. Prednisolone acetate ophthalmic suspensions also contain sodium bisulfite, a sulfite that may cause allergic-type reactions, including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite hypersensitivity in the general population is unknown and probably low.
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