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# Comprehensive Guide to the Use of **Prednisone** (and related oral glucocorticoids)

> **Author:** Your Name
> **Date:** 2024‑04‑27
> **Audience:** Clinicians and pharmacy professionals who prescribe or dispense oral glucocorticoids.

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## 1. Introduction

Oral glucocorticoids such as prednisone, prednisolone, methylprednisolone acetate, and dexamethasone are among the most widely used anti‑inflammatory drugs in modern medicine. They act on a broad range of inflammatory pathways and are effective in many disease states.

This guide summarizes:

- Pharmacology & mechanism
- Approved therapeutic indications (US FDA)
- Dosage ranges & conversion tables
- Contraindications, cautions, drug interactions
- Practical prescribing tips

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## 2. Pharmacology & Mechanism of Action

| Property | Description |
|----------|-------------|
| **Drug Class** | Corticosteroid glucocorticoid |
| **Binding** | Binds to cytoplasmic glucocorticoid receptor (GR) → translocates into nucleus |
| **Genomic Effects** | - Induces anti‑inflammatory proteins (e.g., lipocortin-1, annexin A1)
- Represses pro‑inflammatory genes (IL‑1β, IL‑6, TNFα, COX‑2) |
| **Non‑Genomic Effects** | Rapid membrane‑associated actions; modulate ion channels and signaling pathways |
| **Pharmacokinetics** | Oral bioavailability high (>80%); peak plasma 30–60 min
Half‑life 1.5–3 h (metabolized by CYP3A4)
Protein binding ~90% |
| **Clinical Indications** | • Acute inflammatory conditions:
-- Arthritis, bursitis, tendinitis
-- Gout flares
-- Dental and postoperative pain
• Adjunct to analgesia in trauma or surgery |
| **Contraindications** | • Hypersensitivity to NSAIDs
• Severe hepatic/renal dysfunction
• Uncontrolled peptic ulcer disease
• Pregnancy (3rd trimester) |
| **Drug‑Drug Interactions** | • Anticoagulants (warfarin, heparin): ↑ bleeding risk
• ACE inhibitors / ARBs: ↓ renal perfusion (especially in volume depletion)
• Diuretics: increased NSAID exposure
• Other NSAIDs: additive GI toxicity |
| **Adverse Effects** | • Gastrointestinal irritation, ulceration, bleeding
• Renal impairment, especially in dehydrated or elderly patients
• Hypertension (via sodium retention)
• Fluid overload / edema
• Rare: hypersensitivity reactions |

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## 4. Clinical Decision‑Making

| Situation | Recommendation |
|-----------|----------------|
| **Acute, severe pain after trauma** | Short‑term oral NSAID (e.g., ibuprofen 400–600 mg q6h PRN) *or* short‑term opioid if pain exceeds NSAID efficacy. |
| **Pain moderate to mild but with contraindications to opioids** | Use NSAID alone, ensuring hydration and monitoring renal function. |
| **Patient has chronic pain (e.g., arthritis)** | Long‑term NSAIDs are acceptable if monitored; consider adding disease‑modifying agents if needed. |
| **Pregnancy (especially 1st trimester)** | Ibuprofen/naproxen avoided; acetaminophen preferred. |
| **Elderly with renal impairment** | Prefer acetaminophen or low‑dose ibuprofen with close monitoring of creatinine and electrolytes. |
| **Patients with active GI bleeding** | NSAIDs contraindicated; use acetaminophen or consider H2 blockers/PPIs if needed. |

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## 5. Practical Recommendations for the Clinic

1. **Pain Assessment**
- Use a numeric rating scale (0‑10) and record pain location, duration, and impact on function.
- Document any red flags that might necessitate urgent imaging or referral.

2. **Initial Management**
- **Acetaminophen**: 650 mg–1 g every 4–6 h; max 3 g/day (adjust for liver disease).
- **NSAIDs**: Ibuprofen 400–600 mg qid or diclofenac 50 mg bid; avoid if contraindicated.

3. **Patient Education**
- Explain the limited efficacy of analgesics in chronic pain and the importance of graded activity, weight management, and psychosocial support.
- Discuss side‑effect profiles and when to seek medical attention (e.g., GI bleeding signs, rash).

4. **Follow‑Up & Escalation**
- Reassess after 2–3 weeks; if inadequate response, consider adding a low‑dose opioid or transitioning to centrally acting agents.
- If opioids are prescribed, use strict monitoring (MME

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