You are working a moderately busy evening shift in the pediatric ED. The medical student has just finished presenting the kid he saw in bed eight. The patient is an 8-year-old boy with known asthma, here with an acute exacerbation in the setting of a mild upper respiratory infection. Based on his asthma severity score he is likely to go home, but he is currently wheezing and needs treatment. The student proposes inhaled albuterol and atrovent, which sounds like a good plan. The student wants to order a dose of prednisolone in the ED and then send the patient home with 4 more days of prednisolone to complete a 5-day course. It is what he has seen his preceptors do on other occasions. You suggest a single dose of dexamethasone instead. emergency practice, the common treatment for mild-moderate asthma is 2 mg/kg of prednisone/prednisolone orally in the acute setting, followed by 4 additional days of 1 mg/kg twice daily. In 2001, Cooper and Hickson published a retrospective cohort study of 6,035 Tennessee Medicaid patients ages 2 to 17 years either seen in the ED or admitted to the hospital with asthma. First 4 weeks: 60 mg/m²/day or 2 mg/kg/day PO divided q8hr until urine is protein free for 3 consecutive days; not to exceed 28 days; dose not to exceed 80 mg/day Subsequent 4 weeks: 40 mg/m² or 1-1.5 mg/kg PO every other day; not to exceed 80 mg/day Maintenance in frequent relapses: 0.5-1 mg/kg/dose PO every other day for 3-6 months Treatment may have to be individualized Acne Adrenal suppression Delayed wound healing Diabetes mellitus GI perforation Glucose intolerance Hepatomegaly Hypokalemic alkalosis Increased transaminases Insomnia Menstrual irregularity Myopathy Neuritis Osteoporosis Peptic ulcer Perianal pruritus Pituitary adrenal axis suppression Pseudotumor cerebri (on withdrawal) Psychosis Seizure Ulcerative esophagitis Urticaria Vertigo Weight gain Documented hypersensitivity Systemic fungal infection, varicella, superficial herpes simplex keratitis Receipt of live or attenuated live vaccine; Advisory Committee on Immunization Practices (ACIP) and American Academy of Family Physicians (AAFP) state that administration of live virus vaccines usually is not contraindicated in patients receiving corticosteroid therapy as short-term ( Use with caution in cirrhosis, diabetes, ocular herpes simplex, hypertension, diverticulitis, following myocardial infarction, thyroid disease, seizure disorders, hypothyroidism, myasthenia gravis, hepatic impairment, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, untreated systemic infections, renal insufficiency, pregnancy Thromboembolic disorders or myopathy may occur Delayed wound healing is possible Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored) Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy Parenteral forms (prednisolone sodium phosphate) have been discontinued Suppression of hypothalamic-pituitary-adrenal axis may occur particularly in patients receiving high doses for prolonged periods or in young children; discontinuation of therapy should be done through slow taper Posterior subcapular cataract formation associated with prolonged use of corticosteroids Prolonged use of corticosteroids may increase risk of secondary infections Increase in intraocular pressure associated with prolonged use of corticosteroids Long-term use associated with fluid retention and hypertension Development of Kaposi's sarcoma associated with prolonged corticosteroid use Acute myopathy associated with high dose of corticosteroids Corticosteroid use may cause psychiatric disturbances If product is used for 10 days or longer, intraocular pressure should be routinely monitored even though it may be difficult in children and uncooperative patients; steroids should be used with caution in the presence of glaucoma. Intraocular pressure should be checked frequently Steroids after cataract surgery may delay healing and increase incidence of bleb formation Use of ocular steroids may prolong course and may exacerbate severity of many viral infections of the eye (including herpes simplex) Prednisolone shown to be teratogenic in mice when given in doses 1-10 times human dose; dexamethasone, hydrocortisone, and prednisolone were ocularly applied to both eyes of pregnant mice five times per day on days 10 through 13 of gestation; a significant increase in the incidence of cleft palate observed in fetuses of treated mice; there are no adequate well-controlled studies in pregnant women; prednisolone should be used during pregnancy only if potential benefit justifies potential risk to fetus Not known whether topical ophthalmic administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk; systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects Because of potential for serious adverse reactions in nursing infants from prednisolone, a decision should be made whether to discontinue nursing or to discontinue drug, taking into account importance of drug to mother Glucocorticosteroid; elicits mild mineralocorticoid activity and moderate anti-inflammatory effects; controls or prevents inflammation by controlling rate of protein synthesis, suppressing migration of polymorphonuclear leukocytes (PMNs) and fibroblasts, reversing capillary permeability, and stabilizing lysosomes at cellular level The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. Cheap generic viagra com Is it dangerous to buy clomid online Buy zithromax online ireland When given to infants and younger children, dosage form becomes an important. Dexamethasone is sixfold as potent as prednisone and prednisolone as an. The initial dosage of prednisone may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. In situations of less severity lower doses will generally suffice, while in selected patients higher initial doses may be required. MISSED DOSE If you are taking this medication once daily and miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. If you are taking this medication every other day, ask your doctor or pharmacist what you should do if you miss a dose. Dosing should be individualized based on disease and patient response: Initial dose: 5 to 60 mg orally per day Maintenance dose: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response Comments: -Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 to 8 AM) when dosing. -The delayed-release tablets act similarly to the immediate-release tablets except for the timing of drug release; active drug is released from the delayed-release tablets approximately 4 to 6 hours after intake. -Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups. Uses: As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy as appropriate, such as for the treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation. Dosing should be individualized based on disease and patient response: Initial dose: 5 to 60 mg orally per day Maintenance dose: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response Comments: -Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 to 8 AM) when dosing. -The delayed-release tablets act similarly to the immediate-release tablets except for the timing of drug release; active drug is released from the delayed-release tablets approximately 4 to 6 hours after intake. -Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups. Steroids are hormonal substances that are produced naturally in the body by the adrenal glands (which are just above each kidney) and by the reproductive organs. There are many different types of steroids and they have different effects on the body. These are different to the anabolic steroids used by athletes to enhance their performance. , dexamethasone, fludrocortisone, and occasionally methylprednisolone. Steroids are usually given by mouth in the form of tablets or soluble tablets. They may also be given into a vein (intravenously or IV) through a cannula, central venous catheter or implantable port. If your child is given a short course of steroids, they are unlikely to suffer many side effects. These effects are temporary and will stop when the course of steroids has finished. You may notice that your child becomes irritable and has mood swings. Prednisone dose for kids Prednisone dosage children - MedHelp, Prednisone 10mg Dosage, Side Effects, Interactions, Warning. - RxList Cheap viagra 50mgZoloft substituteCheap viagra in englandAzithromycin dose for stdTamoxifen and weight loss Wean dose of prednisolone are concise point-of-care prescribing, depending on prednisone dosage, side effects and, warnings and children taken every other morning. Oral administration containing either 1 mg, 2010 discussion of initial dose. Pediatric prednisone dosing. PREDNISOLONE LIQUID - ORAL Orapred, Pediapred, Prelone side effects.. Kid with Asthma? Reach for Dexamethasone Medpage Today. Mar 11, 2010. It also explains what side effects or problems your child may have whe. What should you do if your child misses a dose of prednisone. Children with chronic asthma frequently receive "bursts" less than 7 days of short-term, high-dose prednisone 1 to 2 mg/kg/day for acute exacerbations of their. Dosage for Adults Approved by the FDA Food and Drug Administration, prednisone is available in the form of tablets and injections. In general, the treatment starts with a low dosage, after which dose can be altered according to the patient's response to the drug. Needless to say, the recommended dose for children is lower.