Prednisone

Question 1

What are other drugs in the same class as prednisone?

Answer 1

• Methylprednisolone
• Prednisolone
• Hydrocortisone
• Dexamethasone

Question 2

What is Prednisone used for?

Answer 2

as an immunosuppressant or anti-inflammatory medication e.g. as a preventor for asthma or in arthritis treatment

Question 3

What is the mechanism of action for prednisone?

Answer 3

Prednisone = glucocorticoid receptor agonist.

It is a pro-drug and is converted into prednisolone in the liver.

Prednisolone crosses the cell membrane, and binds with high affinity to cytoplasmic receptors of mast cells, eosinophils and glucocorticoid receptors, altering transcription, and protein synthesis.

It down regulates proinflammatory mediators resulting in the inhibition of leukocyte infiltration at the inflammatory site, thus interfering with the inflammatory response, suppressing humoral immune responses, and reducing edema and scar tissue.

Question 4

What are the main pharmacokinetic and pharmacodynamic characterstics of prednisone?

Answer 4

• readily absrobed from GIT and converted to prednisolone by 11β-hydroxysteroid dehydrogenases in the liver
• Preconversion halflife ~1 hour
• Plasma half life ~2-4hours
• excreted in urine as free and conjugated metaoblites

Question 5

What are the precautions with prednisone use?

Answer 5

• Ideally only used when definite diagnosis has been made as signs&symptoms of disease can be masked or inhibited
• Class A (pregnancy&lactation) if dosage is <5mg/day drug
• avoid long term therapy
• supervise use in elderly for osteoporosis, diabetes, hypertension, hypokalaemia
• abrupt withdrawal following chronic use may ppt acute adrenal insufficicency resulting from suppression of the corticotrophin @ the ant. pituitary

Question 6

What are the contraindications for prednisone use?

Answer 6

• hypersensitivity to ingredients in tablet
• systemic acute infections (unless specific anti-infective therapy is given)
• liver virus immunisation
• pancreatitis
• peptic ulcer
• osteoporosis
• psychosis

Question 7

What are the adverse effects with Prednisone?

Answer 7

fatigue
dyspepsia
nausea,
peptic ulceration with perforation and haemorrhage, abdominan pain. diarrhoea, oesophageal ulceration, oesophageal candidiasis, acute pancreaitis
hypokalaemic alkalosis, potassium loss, negative N and Ca balance
Impaired healing, bruising, acne, increased sweating

Question 8

What are the common interactions with prednisone?

Answer 8

May increase blood glucose levels requiring dosage adjustment of any concurrent anti-diabetic therapy

interacts with NSADs e.g. aspirin, ibuprofin, naproxen, celecoxib, diclofenac

Risk of hypokalaemia can be increased with amphoteracin

Question 9

What are some alarm bells regarding prednisone?

Answer 9

Monitor if long term dosage is required
Look out for depression and ulcers
Adjust dosage for patients with other conditions like diabetes, hypertension, liver or renal problems