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Rheumatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Treatment with prednisolone is safe during pregnancy. In aPL-positive patients with pre-eclampsia or HELLP syndrome (haemolysis elevated liver enzymes and low platelet count in association with pregnancy), the possibility of the evolving catastrophic APS must be considered.
Endocrine Disorders, Contraception, and Hormone Therapy during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Prednisone and prednisolone are synthetic glucocorticoids. Prednisone is biologically inert but is metabolized in first pass through the liver to prednisolone, a biologically active compound. Prednisone and prednisolone are used for replacement therapy and to treat a variety of allergic and inflammatory conditions.
The patient with acute respiratory problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Steroids may also be used because of their powerful anti-inflammatory properties. Inhaled steroids are effective in reducing exacerbations in both asthma and COPD. Oral steroids also can reduce airway inflammation and should be prescribed for all patients experiencing an acute asthma attack. Normally, oral doses of prednisolone, 40–50mg daily for up to 5 days, are administered. Intravenous hydrocortisone is a potent anti-inflammatory, but has many common side effects, such as Cushing’s syndrome, electrolyte imbalance, fluid retention and cognitive impairment, and therefore is normally reserved for life-threatening respiratory conditions such as airway obstruction secondary to anaphylactic shock or life-threatening asthma (British Thoracic Society Scottish Intercollegiate Guidelines Network 2016).
Evaluation of switching or simultaneous use of biologic treatment in patients with severe chronic rhinosinusitis with nasal polyps and severe asthma. Considerations in clinical decision making
Published in Expert Review of Clinical Immunology, 2023
Josje Otten, Rik van der Lans, Eugenio de Corso, kanstantsin Dziadziulia, Bart Hilvering, Els Weersink, Matteo Bonini, Jan Hagemann, Wanrawee Thaitrakool, Claudio Montuori, Ludger Klimek, Sietze Reitsma, Wytske Fokkens
Of the 16 patients receiving dupilumab as first choice, 13 switched to mepolizumab and 3 to omalizumab; 9 patients because of (perceived) side effects, 2 with insufficient control of both upper and lower airways, 3 for insufficient control of the CRSwNP and also 3 for insufficient control the asthma (more than one reason may apply). Five patients had hyper-eosinophilia that could not be controlled with lengthening of the dose interval or short-term systemic corticosteroid treatment. Before start of dupilumab treatment, the eosinophil levels of these patients were 0.50, 1.43, 0.94, 3.57, and 0.05 × 109 cells per liter, respectively. The latter patient was using 10 mg of prednisolone daily to control asthma at the time. Thus, in general, baseline eosinophil levels of patients who developed hyper-eosinophilia were high. Treatment duration with dupilumab in these patients ranged from 3 to 24 months. All patients except one showed no clinical manifestations of hyper-eosinophilic syndrome or related end organ damage. One patient developed disabling plantar fasciitis in the left foot. Any association with dupilumab was ruled out by the rheumatologist. Despite that, the multidisciplinary team (otorhinolaryngologist, pulmonologist, and rheumatologist) decided to discontinue dupilumab treatment. For the rest of the patients, dupilumab treatment was stopped after shared decision-making between the otorhinolaryngologist and the patient. Of the 13 patients switching to mepolizumab, 9 remained uncontrolled, 2 switched back to dupilumab, and one eventually ended up undergoing Draf III surgery.
Applications of bupivacaine in the non-surgical treatments of strabismus: a review
Published in Strabismus, 2022
Mohammad Yaser Kiarudi, Seyed Hossein Ghavami Shahri, Acieh Es’haghi, Bahare Gharib, Mohammad-Reza Ansari-Astaneh
The main injection should be performed in 1/3 of the muscle to posterior third of the muscle. The BUP can be used in conjunction with epinephrine 1/100000, assuming that vasoconstriction increases tissue contact and performance. In a recent study by Sadeghi et al., BUP injection was performed without the use of electromyographic guidance.25 The BUP is cardiotoxic in intravenous doses above 1.5 mg/kg. In intravitreal injections, this risk is low, and it is necessary to ensure the absence of intravenous injection. The BUP myotoxicity can cause slight swelling due to muscle necrosis. Consequently, in some studies, oral prednisolone has been used for up to 2 weeks after injection. In most studies, no side effects have been reported except pain and chemosis. Only in a study by Hopker et al., one case of retrobulbar hemorrhage was reported, which was treated with ocular pressure and intraocular pressure control; moreover, after 2 weeks, there was no change in visual acuity.9
Systemic Immunosuppression in Cornea and Ocular Surface Disorders: A Ready Reckoner for Ophthalmologists
Published in Seminars in Ophthalmology, 2022
Corticosteroids have traditionally been the first-line agents in the treatment of many systemic diseases with associated ocular inflammation, like sarcoidosis, systemic lupus erythematosus, rheumatoid arthritis, and vasculitis.1–3 Orally, prednisolone is administered in a dose of 1 mg /kg/day till inflammation is controlled, following which tapering is done in steps of 10 mg initially and 5 mg later, every weekly or fortnightly. A maintenance dose of 5–10 mg is desirable, although, if the duration of steroid use exceeds 6 months, an immunosuppressant agent should be added. For sight – threatening inflammation, intravenous methylprednisolone can be administered in a dose of 1 gm daily over 30 mins, for 3 consecutive days, followed by oral corticosteroids. In case of incomplete response after 2 weeks, or no response after 4 weeks of systemic corticosteroid therapy, an immunosuppressant should be added.4 Adverse effects include hypertension, rise in blood sugar, derangement of lipid profile, osteoporosis and Cushingoid features.5 The risk of a systemic infection especially opportunistic infections is also a serious concern when administering these medications.6 Rare, but serious side effects include pancreatitis, aseptic necrosis of bone, and peptic ulcer disease.7–9 Monitoring of blood pressure, blood glucose, serum cholesterol monthly for the first three months, and then quarterly is recommended.4