What are steroids:
Steroids are artificial hormones that have the same function as the cortisol secreted by the adrenal cortex in the body. Cortisol acts as an anti-inflammatory, anti-allergic, anti-stress, and immunosuppressive agent in the body, regulates the balance of sodium and water, and is responsible for fat and protein metabolism, etc.
 
The amount of steroid secretion varies during daytime and nighttime. In general, human bodies produce a greater amount of steroid during daytime to meet the challenges of daily life, while the amount of secretion decreases at night during rest. This diurnal change meets people's needs in life. In addition, the amount of secretion increases during any critical period over deciding whether to fight or flight, which is an important physiological response in people. At that time, if a disease or a certain factor causes a failure to increase the secretion of steroids, then the result may be life-threatening.
 
Doses and types: 
  1. Oral tablets: Prednisolone 5mg, Methylprednisolone 4mg, etc.
  2. Intravenous injection: Methylprednisolone 125mg, 500mg, 1000mg., etc.
  3. Topical steroid: Locacorten, Nerisone, Visderm-H, Rinderona-V, Topicon, etc.
  4. Inhaled steroid: Beclomethasone dipropionate, Budesonide, Fluticasone propionate, Ciclesonide, etc.
 
Indications:
Steroids are widely used as anti-inflammatory and immunotherapy agents for various diseases, including lung, gastrointestinal, and autoimmune diseases, as well as for transplant patients. For examples, patients with rheumatoid arthritis, systemic lupus erythematosus, polymyositis, nephrotic syndrome, vasculitis, asthma, allergic diseases, autoimmune diseases, hematologic diseases, organ transplantation and adrenal insufficiency usually need to take steroids.
 
Home care and precautions:
  1. Do not take steroids on an empty stomach. If patients experience symptoms of gastrointestinal discomfort after taking steroids, they are recommended to take steroids with food.
  2. People with a history of peptic ulcer, psychosis, uncontrolled diabetes, osteoporosis, glaucoma, and tuberculosis should inform the physician before using steroids.
  3. Patients on long-term medication should bring their medical record card with them at any time for regular follow-up on the effects and adverse reactions.
  4. During medication, patients should inform physician before receiving skin test, any surgery (including tooth extraction) or if they contracted an infection or suffered from injury.
  5. During medication, if patients experience abnormal weight gain, lower limbs edema, muscle weakness, irregular menstruation, tarry stools, vomiting, fever or infection, then they should seek medical attention immediately.
  6. If urticaria, bronchospasm, general redness, contact dermatitis, intractable eczema, and other adverse reactions occur after using the drug, then patients should inform medical staff immediately. Steroid-induced systemic allergies are relatively rare, but are more frequent in patients with aspirin-exacerbated respiration disease.
  7. After dose reduction or discontinuation, patients experiencing abdominal pain, back pain, dizziness, vomiting, long-term loss of appetite, muscle and joint pain, shortness of breath, rapid weight loss, frequent or persistent unexplained headache, fatigue, or disease relapse should seek medical attention immediately.
  8. If patients use an inhaled steroid, they should rinse their mouth after each inhalation to reduce the residual steroid in the mouth, which may cause Candida albicans infection, leukoplakia, and thrush.
  9. Drug storage should avoid high temperature or humidity to prevent drug degradation.
  10. Patients should not discontinue steroid or reduce dose voluntarily. Stopping or reducing by oneself will cause severe health problems, reactivate autoimmune system, causing disease recurrence and even death. Patients discontinuing medication voluntarily may also experience withdrawal syndrome, such as general discomfort, muscle and joint pain, mild fever, headache, diarrhea, and drowsiness. Therefore, patients must follow doctor's orders and should never discontinue or reduce medication voluntarily. The effect on the disease can only be achieved with patients taking medication on time.
  11. What should patients do if they forget to take the medicine?
    1. Daily single-dose: Make it up as soon as possible. If patients take the medicine, on next day, they should not take the medicine they forgot yesterday. Patients should not take twice the medicine at any one time.
    2. Multiple dose per day: Make it up as soon as possible. If patients do not remember to take the medicine until the next time, then they should take 2 doses together.
    3. Next day therapy: If patients forget to take the morning dosage, they should take it as soon as possible if still in the morning. If they do not remember until the evening of the same day, then they should not take the medicine that day. In other words, they stop the medication for one entire day, and take the same dosage on the next day. Resume the same frequency after then.
 
Reference
  1. Davidson, J. E., Fu, Q., Rao, S., Magder, L. S., & Petri, M. (2018).Quantifying the burden of steroid-related damage in SLE in the Hopkins lupus cohort. Lupus Science & Medicine, 5(1). 1-9. doi:10.1136/lupus-2017-000237 
  2. Huang, S. F., & Chuang M. L. (2019). The role of corticosteroid in acute respiratory distress syndrome. Journal of Internal Medicine of Taiwan, 30(5), 305-313.
  3. Shyur S. D. (2017). How to choose appropriate inhaled steroids for asthmatic children. Taiwan Association of Asthma Education, 43, 20-22. doi:10.6669/TAAE.2017.43.20
  4. Yu C.Y. & Tseng C.T. (2019). The use of systemic glucocorticoids in Intensive care units. Formosan Journal of Medicine, 23(5), 649-657. doi:10.6320/FJM.201909_23(5).0011
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