Today, my staff asked - What are the conditions you can do prophylaxis against in a patient with long term steroids?
Guess before you read the answers!
1. Stress ulcers: Use proton pump inhibitors.
Concomitant gastric protection is necessary in patients on long-term, high-dose steroids or taking concomitant non-steroid anti-inflammatory drugs. [1]
2. Osteoporosis: Give them calcium supplements, bisphosphonates, parathyroid hormone.
The newer therapies zoledronic acid and teriparatide are now recommended along with alendronate and risedronate for the treatment of Glucocorticoid Induced Osteoporosis. [2]
3. I couldn't find any guidelines for PCP (pneumocystis jiroveci) prophylaxis but something to think about?
That's all!
Quote for the day: No one is you and that is your power :)
-IkaN
References:
[1] Steroid ulcers: Any news?
Mario Guslandi World J Gastrointest Pharmacol Ther. doi: 10.4292/wjgpt.v4.i3.39
[2] American College of Rheumatology 2010 Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis
Jennifer M Grossman, Rebecca Gordon, et-al DOI 10.1002/acr.20295
Guess before you read the answers!
1. Stress ulcers: Use proton pump inhibitors.
Concomitant gastric protection is necessary in patients on long-term, high-dose steroids or taking concomitant non-steroid anti-inflammatory drugs. [1]
2. Osteoporosis: Give them calcium supplements, bisphosphonates, parathyroid hormone.
The newer therapies zoledronic acid and teriparatide are now recommended along with alendronate and risedronate for the treatment of Glucocorticoid Induced Osteoporosis. [2]
3. I couldn't find any guidelines for PCP (pneumocystis jiroveci) prophylaxis but something to think about?
That's all!
Quote for the day: No one is you and that is your power :)
-IkaN
References:
[1] Steroid ulcers: Any news?
Mario Guslandi World J Gastrointest Pharmacol Ther. doi: 10.4292/wjgpt.v4.i3.39
[2] American College of Rheumatology 2010 Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis
Jennifer M Grossman, Rebecca Gordon, et-al DOI 10.1002/acr.20295
Knowing that PCP typically occurs in HIV-infected patients with a CD4 count <200 cells/microL who are not receiving potent antiretroviral therapy or appropriate prophylaxis, we use cotrimoxazole (sulfamethoxazole-trimethoprim) for prophylaxis against PCP.
ReplyDeletehttp://www.ncbi.nlm.nih.gov/pubmed?term=15488218
This paper "Effect of co-trimoxazole prophylaxis on morbidity, mortality, CD4-cell count, and viral load in HIV infection in rural Uganda." showed that "daily co-trimoxazole prophylaxis was associated with reduced morbidity and mortality and had beneficial effects on CD4-cell count and viral load. Co-trimoxazole prophylaxis is a readily available, effective intervention for people with HIV infection in Africa."
Sorry I don't really know how to quote properly.. but hi, IkaN! :)
Oh yes PCP prophylaxis is done for HIV. But I was looking for an answer in relationship to corticosteroids.
DeleteOh it's fine, love. Hello! :)