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Immunosuppression (Prednisolone (SEs mostly long-term use >6wks (Cardio…

- - - - Inhibits PLA2 → ↓ PG and ↓ PAF
      - ↓ PMN extravasation → ↑ PMN in blood
      - Lymphocyte sequestration in tissues → lymphopenia
      - ↓ Phagocytosis
      - Lymphocyte apoptosis
      - ↓ Ab production
      - ↓ cytokine and proteolytic enzyme release
  - - - Don’t stop steroids suddenly
      - Consult doctor when unwell
      - ↑ dose c¯ illness or stress (e.g. pre-op)
      - Carry a steroid card: dose and indication
      - Avoid OTCs: e.g. NSAIDs
      - Osteoporosis and PUD prophylaxis
      - Ca and vitamin D supplements: Calcichew-D3
      - Bisphosphonates: alendronate
      - PPI: lansoprazole
  - - - HTN
        CCF
    - - Proximal myopathy
        Osteoporosis
    - - Growth suppression
        HPA suppression
        Cushing’s syndrome
    - - Na and fluid retention
        ↑PMN
        ↓K
    - - Depression, psychosis
    - - Cataracts, glaucoma
    - - ↑ susceptibility to infection
    - - Candidiasis
        PUD
        Oesophageal ulceration
        Pancreatitis
- - - - Alemtuzumab (Campath: anti-CD52)
    - - Predniolone 7d
      - Tacrolimus long-term