What are the indications for glucocorticoid therapy?

Glucocorticoids are a widely used clinical treatment method, mainly for anti-inflammatory and anti-toxic treatment. However, caution should be exercised when choosing glucocorticoid treatment. Only the correct and reasonable use of glucocorticoids can improve the effectiveness of treatment.

1. Strictly control the indications for glucocorticoid treatment.

Glucocorticoids are a class of drugs with relatively broad clinical indications, but their clinical application is quite arbitrary, and it is common for them not to be administered strictly according to the indications, such as using glucocorticoids solely for the purpose of reducing fever and relieving pain, especially for the purpose of reducing fever and relieving pain in infectious diseases. Glucocorticoids have the pharmacological effect of inhibiting autoimmunity, but they are not suitable for the treatment of all autoimmune diseases such as chronic lymphocytic thyroiditis (Hashimoto's disease), type 1 diabetes, psoriasis vulgaris, etc.

(ii) Formulate a rational glucocorticoid treatment plan.

The glucocorticoid treatment plan should be formulated based on the patient's condition and the characteristics of the drug. The treatment plan should include the selection of varieties, dosage, course of treatment, and route of administration. Unless the route of administration is clearly stated in these Guidelines, all medications are systemic, i.e. oral or intravenous.

1. Variety selection: Various glucocorticoids have different pharmacodynamics and human pharmacokinetics (absorption, distribution, metabolism and excretion processes), and therefore have different clinical indications. The correct variety of glucocorticoids should be selected based on different diseases and the characteristics of various glucocorticoids.

2. Dosage: Physiological doses and pharmacological doses of glucocorticoids have different effects, and the dose should be selected according to different therapeutic purposes.

3. Pay attention to the comprehensive treatment of diseases.

In many cases, glucocorticoid treatment is only part of the comprehensive treatment of the disease and should be combined with other treatment methods based on the patient's actual situation. For example, for patients with severe infections, glucocorticoids can be used if necessary to relieve symptoms under the premise of active and effective anti-infection treatment and various supportive treatments.

(IV) Monitor adverse reactions of glucocorticoids.

The adverse reactions of glucocorticoids are clearly related to the type of medication, dosage, course of treatment, dosage form and usage. Adverse reactions should be closely monitored during use, such as infection, metabolic disorders (water and electrolytes, blood sugar, blood lipids), weight gain, bleeding tendency, abnormal blood pressure, osteoporosis, femoral head necrosis, etc. Children's growth and development should be monitored.

(V) Pay attention to drug withdrawal reactions and rebound phenomena.

The reduction of glucocorticoids should be individualized under the premise of close observation of the condition and glucocorticoid response, and attention should be paid to the following possible phenomena:

1. Discontinuation reaction: When using glucocorticoids in medium or high doses for a long time, reducing the dosage too quickly or stopping the use suddenly may cause symptoms similar to adrenal insufficiency. Mild cases may show mental depression, fatigue, loss of appetite, joint and muscle pain. Severe cases may cause fever, nausea, vomiting, hypotension, etc. Critically ill patients may even suffer from adrenal cortical crisis, which requires timely rescue.

2. Rebound phenomenon: When using glucocorticoids for a long time, reducing the dosage too quickly or stopping it suddenly may cause the primary disease to relapse or worsen. Glucocorticoid treatment should be resumed and the dosage often needs to be increased. After stabilization, the dosage can be slowly reduced.