manifested by euphoria. These persons may also be unable to sleep (insomnia), have
increased appetite, be nervous or irritable, and be hyperactive.
j. Growth Suppression. Growth is suppressed in children who receive long-
term administration of glucocorticoids in daily, divided doses. Hence, such therapy
should be restricted to children who must receive that type of therapy.
k. Posterior Subcapsular Cataract Formation. This type of cataract formation
is associated with prolonged systemic glucocorticoid therapy and it appears to be dose-
related (e.g., 20 milligrams of Prednisone taken orally for several years). Children are
more frequently affected with this adverse effect than are adults.
9-11. CAUTIONS AND WARNINGS ASSOCIATED WITH GLUCOCORTICOID
The following cautions and warnings are associated with glucocorticoid therapy:
a. Glucocorticoid therapy should be used with the greatest caution in patients
who have the following disorders:
b. Glucocorticoid therapy should be used with caution in patients who have
inactive tuberculosis. (It has been shown that reactivation of tuberculosis can occur in
patients who take glucocorticoids.)
c. Adrenocortical insufficiency can be avoided in patients who are on long-term
glucocorticoid therapy by keeping the dosage as low as possible and by using
intermittent dosage (i.e., taking the drug every other day) when possible.
d. Abruptly stopping prolonged glucocorticoid therapy should be avoided since
this may precipitate acute adrenal insufficiency.
e. All patients who have been on glucocorticoid therapy within four to six months
prior to surgery should be given supplemental doses of glucocorticoids (e.g., 200
milligrams of hydrocortisone a day before surgery and 100 milligrams of hydrocortisone
intravenously at the time of surgery).