Question

Prednisone, beclomethasone, cromolyn, and montelukast all must be administered prophylactically to patients with asthma or allergic rhinitis in order for the medications to be maximally efficacious. However, cromolyn and montelukast can be administered PRN, whereas corticosteroids need to be administered on a fixed schedule (i.e., at the same time each day, regardless of symptoms).

· Why is it that steroids must be administered on a fixed schedule?

· Why is it that long-term use of corticosteroids must be gradually decreased (i.e., tapered) over time, rather than abruptly discontinued?

· How do the side effects of steroids for the treatment of respiratory conditions differ, based on their route of administration (i.e., oral, inhaled, or intranasal)?

Answer 1

1 . Steroids must be taken at fixed schedule as it will mimicks our own body's production of steroids . Usually taken in the morning hours , it is avoided in the night to prevent insomnia.

2 . Long term usage of corticosteroids should not be abruptly stopped as our body would have needed to produce less steroids when there is extrenal supplementation. This tapering the dose and stopping gives the adrenal cortex chance to regain its function slowly.

3. Side effects of oral corticosteroids :

• fluid retention in extremities.
• Mood swings
• Elevated blood pressure.
• Elevated pressure in the eyes.

Side effects of intranasal corticosteroids :

• Dryness and irritation in the nasal mucosa.
• Nosebleeds.
• Unpleasant taste in the mouth.
• Nasal bleeds occasionally.

Side effects of inhaled corticosteroids :

• Tachycardia.
• Weakness
• Cough and hoarseness of voice.
• Oral thrush.
• decreased growth in children in case of long term usage of inhaled corticosteroids.
• Decreased immune system.