What is the most important teaching point for a client newly prescribed long-term corticosteroid therapy (prednisone)?

Long-term exogenous corticosteroids suppress the hypothalamic-pituitary-adrenal (HPA) axis. After about 2-3 weeks of suppressive doses, the adrenal glands stop producing endogenous cortisol. Abrupt discontinuation can cause acute adrenal insufficiency (Addisonian crisis): severe weakness, hypotension, shock, hypoglycemia, hyperkalemia, life-threatening — requires emergency IV cortisol replacement. To prevent this, corticosteroids are tapered gradually over weeks to months, allowing the HPA axis to recover. Other key teaching: (1) Take with food to reduce GI upset; (2) Monitor for hyperglycemia, especially with pre-existing diabetes; (3) Long-term effects include osteoporosis (calcium and vitamin D recommended, sometimes bisphosphonates), cataracts and glaucoma, weight gain, mood changes, immunosuppression (avoid sick contacts); (4) Avoid live vaccines while immunosuppressed; (5) Report signs of infection promptly (corticosteroids mask classic signs); (6) Monitor blood pressure and weight. Stress-dose steroids may be needed during illness or surgery.