Prednisone is a corticosteroid that I see used almost on a daily basis in my practice. There are many important clinical pearls that will show up in practice as well as on your board exams. In this blog post, I will share my top 5 prednisone clinical pearls.
Hyperglycemia
Hyperglycemia is a significant problem in patients with diabetes. A prednisone “burst” of 10-40 mg over a few days to a week or two can cause big increases in blood sugars. Patients who have historically had tight control over the diabetes can get very upset about this. Patient education is important and recognizing that this is temporary is good to remember.
HPA Suppression
HPA suppression is a concern if patients start to taking prednisone longer than a couple weeks. Essentially long term use of prednisone can negatively impact the body’s ability to produce cortisol. This can lead to adrenal crisis if the prednisone is abruptly stopped. Common signs and symptoms of adrenal crisis include severe hypotension and tachycardia. Electrolyte imbalances such as hyponatremia, hyperkalemia, and hypoglycemia are frequently seen as well.
Administration
There are two things to remember with oral prednisone. GI concerns can happen and taking the medication with food is important to help alleviate this problem. The other important aspect of prednisone administration is timing. It is typically better to take prednsione earlier in the day to try to reduce the adverse effect of insomnia.
Vaccine Administration
Twenty milligrams of prednisone or more can interrupt vaccine administration. This dose can essentially reduce the effectiveness of the immune response to the vaccine. It is important to administer vaccines weeks before utilizing prednisone or several weeks after otherwise vaccine effectiveness may decrease and you will have to revaccinate.
Osteoporosis
The last of my top five prednisone clinical pearls is in relation to bone health. It isn’t very common but when you have patients who take long term prednisone, it is important to assess for the risk of osteoporosis. Prednisone can reduce osteoblast (bone builders) activity and cause an increase in the action of osteoclasts. Osteoclasts break down bone. This leads to an increase in the risk for osteoporosis. Patients who need long term prednisone should be assessed for osteoporosis therapy with medications such as alendronate.
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