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PH7.5 | PH7.5 | Corticosteroid Pharmacotherapy — SDL Guide — SDL Guide (Part 3)
Self-Assessment: Corticosteroid Prescribing Scenarios
Apply your pharmacological reasoning to these clinical scenarios:
Scenario A: A 30-year-old woman with newly diagnosed lupus nephritis (class III LN) is to start prednisolone 60 mg/day. List FOUR concurrent prescriptions you would add, with the pharmacological justification for each.
Answer: (1) Alendronate 70 mg weekly — GIO prophylaxis (high-dose, long-course steroid); (2) Calcium 1000 mg + Vitamin D 800 IU daily — adjunct to bisphosphonate for bone protection; (3) Omeprazole 20 mg OD — PPI for GI protection (especially if co-prescribed with NSAIDs or on immunosuppressants that may cause GI effects); (4) Screen for TB (Mantoux/IGRA) before starting — immunosuppression risks TB reactivation; prophylactic isoniazid if latent TB detected. Bonus: glucose monitoring (steroid diabetes risk at 60 mg/day).
Scenario B: You are prescribing a 5-day course of prednisolone 40 mg for an acute asthma exacerbation. The patient asks if they can stop taking it if they feel better after day 2. What do you advise?
Answer: Do not stop early. Five days of prednisolone for an asthma exacerbation does not require tapering (short course, <3 weeks), but completing the full course prevents rebound bronchospasm and asthma relapse. Stopping after day 2 risks symptom recurrence. Only a course >3 weeks requires a formal taper to avoid HPA axis suppression. Counsel: take with food or milk to reduce GI irritation; complete the course; return if symptoms worsen or if fever develops (steroid immunosuppression).
SELF-CHECK
A patient asks: 'My doctor prescribed steroid tablets for one month. Is it safe to stop them suddenly next week when I feel better?' Your response should be:
A. A. 'Yes, stop immediately if you feel better — you don't need the full course'
B. B. 'If you've been on them for only one week, you can stop; if it has been more than 3 weeks, you must taper gradually'
C. C. 'All steroids must be tapered regardless of duration'
D. D. 'Never stop steroids; the doctor will adjust the dose at your next visit'
Reveal Answer
Answer: B. B. 'If you've been on them for only one week, you can stop; if it has been more than 3 weeks, you must taper gradually'
The tapering rule is duration-dependent. Courses under 2–3 weeks: HPA axis suppression is minimal — can stop without tapering (though should complete the prescription as directed for disease control). Courses over 3 weeks: suppression of HPA axis has occurred — abrupt stopping risks acute adrenal insufficiency; must taper gradually. The practical guidance: short course (<3 weeks) as prescribed — complete but no formal taper needed. Long course (>3 weeks) — ALWAYS taper. The patient in this question has been on a 1-month (4-week) course — tapering is required.