Speaker #1corticoids, medical indications and specificities, reminders to professionals and students. Welcome to this complementary episode of Science in Light. Today, we are going to dive into a crucial subject for health professionals. The management of corticoids, their medical indications, and how to optimize their use in clinical practice. This episode will also deepen the specific dosages, tout en couvrant les recommandations de chronopharmacologie pour maximiser l'efficacité des corticoïdes et minimiser les effets secondaires. Nous aborderons en dernière partie un rappel des recommandations 2024 concernant la surveillance clinique à mettre en place pour les patients sous corticoïdes pendant plus de trois semaines. Ce podcast est écrit et réalisé par Christophe Blin, docteur en pharmacie. Rappel des conseils hygiéno-diététiques. Avant de passer à des aspects plus techniques, Let's briefly recall the essential hygiene and diet advice for patients with corticoids. These measures allow to minimize the side effects such as water retention, osteoporosis or hypertension. It is first recommended to reduce the intake of salt to avoid water retention. Then, it is important to control the caloric intake, because corticoids can stimulate appetite, thus increasing the risk of weight gain. Regarding bone health, corticoids can weaken bones. So make sure that patients receive enough calcium and vitamin D to prevent osteoporosis. A surveillance of glycemia is also crucial, especially for patients at risk of diabetes, because corticoids can increase the sugar level in the blood. Regular physical activity plays an essential role in maintaining muscle mass and bone density, while promoting better stress management. Finally, we must not forget the management of sleep and stress, because corticoids can disturb rest, et augmenter l'irritabilité. Ces conseils sont simples mais efficaces pour garantir une meilleure qualité de vie aux patients sous corticoïdes. Partie 1, indications thérapeutiques des corticoïdes. Voyons maintenant les principales indications thérapeutiques des corticoïdes, qu'ils soient utilisés pour leurs effets anti-inflammatoires ou immunosuppresseurs. Les indications anti-inflammatoires et immunosuppressives. Les corticoïdes sont essentielles pour traiter un large éventail de maladies d'auto-immunes comme le lupus erythémateux systémique. poliartrite rheumatoid and dermatomyositis. In these pathologies, they help to modulate the immune response and reduce inflammation. They are also used in chronic inflammatory diseases, such as severe asthma and obstructive chronic bronchopneumopathy, to limit bronchial inflammation and improve breathing. Finally, in inflammatory intestinal diseases, such as Crohn's disease and hemorrhagic rectocolitis, corticoids are effective in controlling inflammatory growth, Although a background treatment with immunosuppressants is often necessary in the long term to limit the secondary effects. Urgent and acute indications In urgent situations, corticoids allow for quick and effective management of serious inflammatory crises. In cases of anaphylactic shock, dexamethasone or methylprednisolone are administered in addition to antihistaminic and adrenaline to calm the systemic inflammatory response. In case of severe asthma crisis Prednisone or methylprednisolone are used to quickly reduce the inflammation of the respiratory tract and restore the respiratory function. Finally, let's see their use during acute exacerbation of the BPCO. The use of systemic corticoids allows to improve the respiration by reducing the inflammation of the bronchi. Part 2. The different types of corticoids and their clinical dosage. Now, let's discuss the different types of corticoids, whether systemic, inhaled or topical. as well as the recommended dosages for each clinical situation. 1. Systemic, oral and injectable corticoids. Systemic corticoids, administered by oral or injectable, are used to obtain rapid and powerful effects on inflammation and immunosuppression. Here is an overview of the main molecules and their recommended dosages. Prednisone and prednisolone. These are the most used oral corticoids in chronic diseases such as rheumatoid polyarthritis and asthma. In general, The recommended dosage is 0.5 to 1 mg per kg and per day for adults. In severe exacerbations, for example in asthma, doses can be increased up to 1 to 2 mg per kg and per day on a short period before progressively reducing the posology. Dexamethasone. With a half-life and a power this time superior to that of prednisone, dexamethasone is often used in acute situations such as cerebral edema or septic shocks. The standard dosage varies from 0.1 to 0.2 mg per kg and per day, administered by oral or intravenous way, depending on the severity. For cerebral edema, we often administer an initial dose of 10 mg in intravenous, followed by 4 mg every 6 hours. Methylprednisolone. Administrated by intravenous voeux, methylprednisolone is used in acute sclerosis of autoimmune diseases such as sclerosis of the lupus. In other serious inflammatory affections, the dosage varies from 0.5 to 1 mg per kg and per day. These systemic corticoids allow to quickly control the inflammation, but rigorous monitoring is necessary to limit the side effects, especially during prolonged use. 2. Inhaled corticoids Inhaled corticoids, such as budesonide or fluticasone, are mainly used for long-term treatment of respiratory diseases such as asthma or BPCO. Their main advantage is that they act directly in the respiratory tract, thus limiting the systemic effects. For moderate to severe asthma, The recommended dosage of inhaled corticoids varies between 400 and 1600 micrograms per day, divided into two doses. For the BPCO, the doses can be higher, often from 800 to 2000 micrograms per day, always combined with bronchodilators. 3. Topic corticoids Topic corticoids are mainly used to treat dermatological infections such as eczema or psoriasis. Their power must be adapted to the affected area and to the application area. For sensitive areas such as the face, corticoids of low power are used, such as 1% hydrocortisone, applied once or twice a day. For resistant affections or thick cutaneous areas, corticoids of moderate to strong power are prescribed, such as betamethasone or clobetasol, used with caution to avoid cutaneous fragilisation or bruises. Part 3. The chronopharmacy of corticoids. A often underestimated aspect in the management of corticoids is chronopharmacy. i.e. the optimal time for taking the drug in order to maximize its effectiveness and reduce undesirable effects. Ideally, corticoids must be taken in the morning, between 6 and 8 o'clock, to respect the circadian rhythm of cortisol, the hormone naturally produced by the surrenal glands at this period. Taking corticoids at this time helps to reduce sleep disorders that can be caused by a late intake. This also allows to minimize systemic effects, such as increased glycemia or hormonal disturbances. Part 4. Severe corticoid and therapeutic strategies. After a long treatment of corticoids, it is essential to proceed to a progressive semen semen to avoid a surrenal insufficiency. The semen must be performed by reducing the dose from 10 to 20% every 1 to 2 weeks, by monitoring the signs of relapse or semen, such as fatigue or joint pain. In oncology and in palliative care, corticoids are used to manage the nausea induced by chemotherapy, reduce brain inflammation in metastases, or improve appetite in patients in terminal phase. The choice of type of corticoid and its dosage depend on the therapeutic objective and patient's tolerance. In the context of an oral corticotherapy, i.e. when the treatment lasts 3 weeks, several aspects of surveillance are essential to ensure the safety and well-being of the patient. Let's see together the key points not to neglect. First of all, it is crucial to look for clinical signs of diabetes, such as intense thirst or abundant urine. A glycemic measurement must be performed at least once or twice a year to monitor the possible appearance of hyperglycemia. Then, the signs of sodium and water retention must be carefully monitored. This includes symptoms such as unexplained weight gain, increased blood pressure, edema, or even a high dyspnea. Caliémie, that is the potassium in the blood, must be controlled during these prolonged corticoid treatments at least once or twice a year, and more frequently if the patient is under treatment with a drug that is likely to cause hypokalemia or pointed torsades. In addition, to prevent eye complications, it is recommended to consult an ophthalmologist every 6 to 12 months to detect signs of glaucoma or cataract, especially if the treatment by corticoid lasts more than 6 months. It is also important to avoid pain evoking an osteoporotic fracture or osteonecrosis. A measure of the size of the patients once a year can help to reduce a loss of size linked to osteoporosis. An osteodensitometry is recommended after a year of treatment, especially in patients who do not receive preventive treatment by biphosphonate. Finally, it is necessary to remain vigilant when it comes to clinical signs of infection, whether respiratory, urinary or other, especially if the patient is under a concomitant immunosuppressant treatment. It is also important to note that the attenuated agent vaccines must be avoided up to 3 months after the stop of these long-term corticoid treatments in order to avoid any complications. These points of surveillance are crucial to minimize the risks associated with prolonged corticotherapy and ensure a secure takeover. In conclusion, In this episode, we have examined in depth the different indications of corticoids, their types, as well as the management of dosages and chronopharmacology to optimize their effectiveness and limit the secondary effects. These medicines are powerful therapeutic tools, but need precise management to prevent long-term complications. Thank you for listening to this episode of Science in Light, written and directed by Christophe Blin. Do not hesitate to contact us for any questions or suggestions. See you soon, after you are subscribed. For a new enlightening subject. The sources of this episode are specified in the description.
Speaker #0podcast, corticosteroids, medical indications and specifics, a reminder for professionals and students. Welcome to this supplementary episode of Science en Lumiere. Today we will delve into a crucial topic for healthcare professionals, the management of corticosteroids, their medical indications, and how to optimize their use in clinical practice. This episode will also focus on specific dosages and cover chronopharmacology recommendations to maximize the efficacy of corticosteroids while minimizing side effects. In the last part, we will revisit the 2024 recommendations for clinical monitoring in patients undergoing corticosteroid treatment for more than three weeks. This podcast is written and produced by Christoph Blinn, doctor of pharmacy. Reminder of hygienic and dietary advice. Before diving into the more technical aspects, let's briefly recap the essential hygienic and dietary advice for patients on corticosteroids. These measures help to minimize side effects such as water retention, osteoporosis, and hypertension. First, it is recommended to reduce salt intake to avoid water retention. Then, it is important to control caloric intake, as corticosteroids can increase appetite, thus raising the risk of weight gain. Regarding bone health, Corticosteroids can weaken bones, so it's crucial to ensure patients receive adequate calcium and vitamin D to prevent osteoporosis. Monitoring blood glucose levels is also essential, particularly in patients at risk for diabetes, as corticosteroids can elevate blood sugar. Regular physical activity plays an essential role in maintaining muscle mass and bone density, while also helping to better manage stress. Finally, do not forget to address sleep and stress management. as corticosteroids can disrupt sleep and increase irritability. These simple but effective tips help ensure a better quality of life for patients undergoing corticosteroid therapy. Part 1. Therapeutic Indications of Corticosteroids Now let's explore the main therapeutic indications of corticosteroids, whether they are used for their anti-inflammatory or immunosuppressive effects. Anti-inflammatory and immunosuppressive indications Corticosteroids are essential in treating a wide range of autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and dermatomyositis. In these conditions, corticosteroids help modulate the immune response and reduce inflammation. They are also used in chronic inflammatory diseases, such as severe asthma and COPD, chronic obstructive pulmonary disease, to limit bronchial inflammation and improve breathing. Finally, In inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis, corticosteroids are effective in controlling inflammatory flares, although long-term treatment often requires immunosuppressants to limit side effects. Emergency and acute indications. In emergency situations, corticosteroids allow for rapid and effective management of severe inflammatory crises. Anaphylactic shock. Dexamethasone or methylprednisolone is administered alongside antihistamines and adrenaline to calm the systemic inflammatory response. Severe asthma attacks. Prednisone or methylprednisolone is used to quickly reduce airway inflammation and restore respiratory function. Acute exacerbations of COPD. Systemic corticosteroids improve breathing by reducing bronchial inflammation. Part 2. Different types of corticosteroids and their clinical dosages. Let's now discuss the various types of corticosteroids, systemic, inhaled, and topical, as well as the recommended dosages for each clinical situation. 1. Systemic corticosteroids, oral and injectable. Systemic corticosteroids, administered orally or via injection, are used to achieve rapid and potent effects on inflammation and immunosuppression. Here's an overview of the main molecules and their recommended dosages. Prednisone and prednisolone. These are the most commonly used oral corticosteroids for chronic conditions such as rheumatoid arthritis and asthma. The recommended dosage is generally 0.5 to 1 mg per kg per day for adults. In cases of severe exacerbation, such as in asthma, the doses can be increased to 1 to 2 mg per kg per day for a short period before gradually tapering the dosage. Dexamethasone, with a long half-life and potency 7 times greater than prednisone, Dexamethasone is often used in acute situations such as cerebral edema or septic shock. The standard dosage ranges from 0.1 to 0.2 mg per kg per day, administered orally or intravenously depending on the severity. For cerebral edema, an initial dose of 10 mg intravenously, followed by 4 mg every 6 hours, is commonly used. Methylprednisolone, administered intravenously, Methylprednisolone is used during acute flares of autoimmune diseases, such as multiple sclerosis or lupus. In an acute multiple sclerosis flare-up, the typical regimen is 500 mg to 1 g per day via intravenous infusion for 3 to 5 days. In other severe inflammatory conditions, the dosage is 0.5 to 1 mg per kg per day. These systemic corticosteroids provide rapid control of inflammation. but strict monitoring is required to limit side effects, particularly during prolonged use. 2. Inhaled corticosteroids. Inhaled corticosteroids, such as budesonide or fluticasone, are primarily used for the long-term management of respiratory diseases like asthma or COPD. Their main advantage is that they act directly on the airways, thereby minimizing systemic effects. 4. Moderate to severe asthma. The recommended dosage of inhaled corticosteroids ranges from 400 to 1600 micrograms per day, divided into two doses. For COPD, the doses can be higher, often between 800 and 2000 micrograms per day, always combined with bronchodilators. 3. Topical Corticosteroids. Topical corticosteroids are primarily used to treat dermatological conditions such as eczema or psoriasis. The potency of the corticosteroid must be tailored to the condition being treated and the area of application. For sensitive areas like the face, low-potency corticosteroids, such as 1% hydrocortisone, are applied once or twice daily. For more resistant conditions or thicker skin areas, moderate to high-potency corticosteroids, such as betamethasone or clobetasol, are prescribed with caution to avoid skin thinning or stretch marks. Part 3. Corticosteroid Chronopharmacology. A frequently overlooked aspect of corticosteroid management is chronopharmacology, the optimal timing for taking the medication to maximize its effectiveness and reduce side effects. Ideally, corticosteroids should be taken in the morning, between 6 a.m. and 8 a.m., to mimic the natural circadian rhythm of cortisol, the hormone naturally produced by the adrenal glands during this time. Taking corticosteroids at this time helps reduce sleep disturbances that can result from a late dose. It also helps minimize systemic effects, such as elevated blood glucose or hormonal disruptions. Part 4. Corticosteroid Tapering and Therapeutic Strategies After a prolonged course of corticosteroids, it's essential to implement gradual tapering to avoid adrenal insufficiency. Tapering should be done by reducing the dose by 10-20% every 1-2 weeks. while monitoring for signs of relapse or withdrawal, such as fatigue or joint pain. In oncology and palliative care, corticosteroids are used to manage chemotherapy-induced nausea, reduce cerebral inflammation in metastases, or improve appetite in terminal patients. The choice of corticosteroid and dosage depends on the therapeutic goal and the patient's tolerance. Monitoring during long-term corticosteroid therapy. For patients undergoing long-term oral corticosteroid therapy, more than three weeks, several monitoring aspects are essential to ensure patient safety and well-being. Let's go over the key points. First, it is crucial to look for signs of diabetes, such as excessive thirst or frequent urination. Blood glucose should be checked at least once or twice a year to monitor for potential hyperglycemia. Next, signs of sodium and water retention should be closely monitored. This includes symptoms such as unexplained weight gain, increased blood pressure. edema, or shortness of breath with exertion. Serum potassium levels should be checked at least once or twice a year, or more frequently if the patient is also taking medications that can cause hypokalemia or torsades to points. To prevent ocular complications, it's recommended to see an ophthalmologist every 6 to 12 months to check for signs of glaucoma or cataracts, especially if the corticosteroid treatment lasts more than 6 months. It's also important to assess for pain that may suggest osteoporotic fractures or osteonecrosis. Measuring the patient's height once a year can help detect height loss due to osteoporosis. Bone density scans are recommended after one year of treatment, especially in patients not receiving preventive treatment with bisphosphonates. Finally, be vigilant for signs of infection, whether respiratory, urinary, or other, especially if the patient is also taking immunosuppressive medications. Live vaccines should be avoided for up to three months after discontinuing long-term corticosteroid treatment to prevent complications. Conclusion In this episode, we've thoroughly examined the various indications of corticosteroids, their types, dosage management, and chronopharmacology to optimize their effectiveness while minimizing side effects. These drugs are powerful therapeutic tools, but they require precise management to prevent long-term complications. Thank you for listening to this episode of Science en Lumiere, written and produced by Christophe Glynne. Don't hesitate to contact us with any questions or topic suggestions. See you soon, and don't forget to subscribe for more enlightening discussions. The sources for this episode are listed in the description.
