Adalimumab fever — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsAdalimumab feverGPhC CRA

A patient with polymyalgia rheumatica has taken prednisolone 7.5 mg daily for eight months. They have vomited repeatedly for 24 hours, cannot retain tablets and are dizzy on standing. What should the pharmacist advise?

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Correct answer: E — Arrange urgent adrenal assessment and parenteral steroid treatment

Arrange urgent adrenal assessment and parenteral steroid treatment: Long-term prednisolone can suppress the hypothalamic–pituitary–adrenal axis; inability to retain steroid during an intercurrent illness with postural symptoms risks adrenal crisis. Omit prednisolone until food and fluids are tolerated: Abrupt omission during acute illness increases rather than reduces adrenal-crisis risk. Take two oral prednisolone doses after vomiting settles: The patient cannot currently retain oral treatment and needs urgent assessment rather than delayed dose stacking. Replace prednisolone temporarily with an oral NSAID: An NSAID does not provide glucocorticoid replacement and cannot prevent adrenal crisis. Retry the usual oral dose and seek review after forty-eight hours: Persistent vomiting and postural symptoms require urgent treatment escalation, not further delay.

Reference: BNF: prednisolone: https://bnf.nice.org.uk/drugs/prednisolone/; Society for Endocrinology: adrenal crisis guidance: https://www.endocrinology.org/clinical-practice/clinical-guidance/adrenal-crisis/