Corticosteroids – Frequently Asked Questions Part 2 | Johns Hopkins

By Adem Lewis / in , , , , , , /

(relaxed music) – Hi, I’m Vicky Ruffing. I am the Director of Patient Education at the Johns Hopkins Arthritis Center. – And my name is Dr. Rebecca Manno. I’m an Assistant Professor of Medicine at the Johns Hopkins
division of Rheumatology in the Johns Hopkins Arthritis Center. Welcome to part two of frequently asked questions about corticosteroids. – [Vicky] Our first question
is I’m going on vacation. What if I run out of my prednisone? – Whenever preparing for
travel, it is important to talk to your doctor about having an adequate supply of
all of your medications, but especially your
corticosteroid or your prednisone. You may want to ask your
doctor for a vacation supply just in case something happens to your medication during your travels. But sometimes things happen. Maybe your luggage gets
lost or you miscounted how many steroid or prednisone
tablets that you have. If you do run out of your prednisone, call your doctor immediately. They can usually refill your prescription at a local pharmacy. As we discussed in part one
of frequently asked questions, it is important that you don’t stop your prednisone suddenly. If you do miss a dose, take your next dose at the time it is normally prescribed. – [Vicky] Our next question
is about vaccinations. If I am going to get a vaccine, is that safe while I’m on prednisone? – Vaccinations are incredibly important for all of our patients who
are on immunosuppression. Vaccines can protect
against very vicious viruses and infections that can
cause a lot of problems. If you’re on prednisone and
you’re receiving a vaccine, you need to know if the
vaccine is a live vaccine or a killed or an inactivated vaccine. Some live vaccines may not be appropriate while on immunosuppression, and specifically, high
doses of prednisone. Vicky, how so you council patients on the flu vaccine while on prednisone? – Well, of course we
encourage all patients to get the flu vaccine as
well as the pneumonia vaccine. Now, the flu vaccine
does not cause the flu. It is not a live vaccine. It is a synthetic, if you will, vaccine against the flu. We do not see patients come down with the flu if they’ve gotten a vaccine. I just can’t stress
enough how important it is for our patients to get the flu vaccine just so that they can
help boost their immunity and their resistance against flu, which of course can be deadly. – That’s great advice, Vicky. So a scenario that comes
up quite frequently, Vicky, especially among my patients
who have been on prednisone for a long period of
time, maybe for conditions such as polymyalgia rheumatica
or rheumatoid arthritis or giant cell arteritis, and
they’ve been slowly tapered off the prednisone, maybe over a
course of months or even years, so they’re off prednisone, but
then something new happens. For example, they get poison ivy, or they have a terrible asthma attack, and their doctor recommends
a short course of prednisone to treat a different condition. This can cause some stress, anxiety, and a lot of questions for patients. How do you council
patients in this situation? – Well naturally I think
that patients are afraid that they’ll be tied to
their prednisone again, where they may have to have that long period of months to taper off. So it’s a natural concern
for patients to have. However, what I like to
tell patients is that when we want to use
prednisone in a short burst, it’s for a specific reason, and
there is a time limit to it. So a patient’s gonna
start it and complete it within two weeks to a month. So it starts high with a higher does and then tapers down quickly, so you do not see that prolonged taper that’s needed when patients have been taking prednisone for
a long period of time. It’s important to treat
whatever the condition is that’s requiring that
short burst of prednisone, so we need to weigh risk and benefit, and it’s definitely
more on the benefit side to go with that short burst of prednisone. – I absolutely agree,
Vicky, and it gets back to a point we made in
one of the earlier videos about whenever prednisone or
a steroid is being prescribed, as a patient it’s important
to discuss with your doctor what is the dose, what is the indication, what is the duration,
and what can I expect to see as far as benefit
before you start the medicine. (relaxed music)

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