Steroid sparing medications

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Potential adverse effects of chronic corticosteroid therapy should be weighed against the clinical benefits obtained and the availability of other treatment alternatives. Prolonged systemic corticosteroid therapy can lead to osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humoral heads, and pathologic fractures of long bones secondary to decreased bone formation, increased bone resorption, and protein catabolism in any patients. A high-protein diet may alleviate or prevent the adverse effects associated with protein catabolism. The elderly, post-menopausal, and pediatric patients may be more susceptible to the effects on bone. Chronic systemic triamcinolone therapy may cause growth inhibition in pediatric patients due to hypothalamic-pituitary-adrenal axis suppression and inhibition of bone growth. Corticosteroids should be titrated to the lowest effective dose. Because bone development is critical in pediatric patients, monitoring is warranted in patients receiving high-dose or chronic corticosteroid treatment. Growth inhibition may also occur with intranasal or topical triamcinolone due to systemic absorption, particularly in susceptible patients or when used in high doses or for prolonged periods of time. Use of the lowest effective dose is recommended to minimize the occurrence of systemic adverse effects. Monitor growth routinely.

It is important to consult your doctor to discuss the possible risks of ceasing topical steroids. While adrenal suppression and HPA axis suppression generally resolve by ceasing topical steroid therapy, caution must be exercised. Stopping topical steroids when the adrenal glands are severely depressed can risk adrenal crisis, which is life-threatening. Your doctor can run tests to determine cortisol levels and adrenal function prior to cessation of topical steroids and can continue follow-up during your withdrawal. Reading relevant research from scholarly, peer-reviewed journals will help you learn more about this condition. Finding a support group or joining online communities may offer additional support.

Andreoli, . et al. (1997): Cecil Essentials of Medicine; (4-th ed.)- Company,.
Fauci, . et al. (1998): Harrison’s principles of internal medicine; (14-th ed.)-The McGraw-Hill Companies INC.,.
Shiau, ., Toren, . (2006): The Toronto Notes 2006: Comprehensive Medical References, 26-nd Ed., Canada.
Tierney, . (1997): Pocket guide to the essentials of diagnosis and treatment; (1-th ed.)- Lange medical book, .
Younger-Lewis,C.; Complete home medical guide;Canadian Medical Association (1-st ed.), Dk Publishing Inc.

The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.

Steroid sparing medications

steroid sparing medications

Andreoli, . et al. (1997): Cecil Essentials of Medicine; (4-th ed.)- Company,.
Fauci, . et al. (1998): Harrison’s principles of internal medicine; (14-th ed.)-The McGraw-Hill Companies INC.,.
Shiau, ., Toren, . (2006): The Toronto Notes 2006: Comprehensive Medical References, 26-nd Ed., Canada.
Tierney, . (1997): Pocket guide to the essentials of diagnosis and treatment; (1-th ed.)- Lange medical book, .
Younger-Lewis,C.; Complete home medical guide;Canadian Medical Association (1-st ed.), Dk Publishing Inc.

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