Corticosteroids: Chapter 17

• Corticosteroids are explored in Chapter 17.

Corticosteroids Overview

• Hormones produced in the adrenal cortex or gonadal organs.
• They help maintain homeostasis when secreted in normal amounts.
• They require close monitoring because of profound therapeutic and adverse effects.

Glucocorticoids

• Glucocorticoids are also known as corticosteroids or steroids.
• They are used for anti-inflammatory and anti-stress effects.
• Glucocorticoids typically end in "-sone".
• They are administered to aid the body during stress.

Indications for Corticosteroid Usage

• Respiratory disorders.
• Rheumatic disorders.
• Shock.
• Used palliatively, not curatively.
• Symptoms reduced to a tolerable level.

Corticosteroid Side Effects

• Decreased growth in children.
• Glaucoma.
• Centripetal distribution of body fat.
• Negative calcium balance.
• Impaired wound healing.
• Hirsutism.
• Osteoporosis.
• Increased risk of infection.
• Increased appetite.
• Emotional disturbances, euphoria, and depression.
• Peptic ulcer.
• Hypertension.
• Peripheral edema.
• Hypokalemia.

7 S's of Steroid Precautions

• Swollen.
• Sepsis or infection from low WBCs.
• Sugar increased.
• Skinny muscles and bones.
• Sight problems.
• Slower taper off.
• Stress or surgery considerations.

Glucocorticoid Prototype: Prednisone

• Common brand names: Deltasone, Intensol, Rayos
• Other drugs in this class: beclomethasone, betamethasone, dexamethasone, fluticasone, hydrocortisone, methylprednisolone.

Pharmacokinetics

• Absorption rate is dependent on administration route.
• Oral administration results in rapid GI tract absorption.

Special Populations

• Corticosteroids are used in children for the same conditions as in adults; asthma commonly.
• Children with severe asthma might require ongoing corticosteroid treatment.
• Use moderate dosage of inhaled corticosteroids for children with asthma.
• Exercise caution in older patients.
• Prescribe the lowest dose with the shortest administration duration.
• Prednisone is preferred for treating maternal conditions during pregnancy because placental enzymes limit passage to the embryo.

Use of Corticosteroids

• Corticosteroids control symptoms.
• Corticosteroids does not cure underlying disease process.

Allergic Rhinitis

• Administer corticosteroids via nasal spray once or twice daily.
• An example is Fluticasone-Flonase
• Drugs decrease mucus secretion and inflammation.
• Minimal systemic adverse effects happen with recommended doses.
• Higher doses may cause adrenocortical insufficiency through hypothalamic-pituitary-adrenal suppression.

Arthritis

• The most effective drugs for rapid pain relief, edema reduction, and restricted mobility relief related to acute joint inflammation.
• When inflammation is in three or fewer joints, inject drugs directly into the joint.
• Disease progression and joint destruction are unpreventable.

Asthma

• Asthma commonly treated with corticosteroids.
• Corticosteroids intensify the effects of adrenergic bronchodilators to prevent or treat bronchoconstriction and bronchospasm.
• Admininster high doses orally or IV with bronchodilators in acute asthma or status asthmaticus for about 5 to 10 days.
• Systemic corticosteroids are for short-term therapy as needed, not for long-term treatment.
• Gradually reducing the dose is necessary once acute symptoms subside, with the goal of using the lowest effective maintenance dose or stopping the drug.

Cancer

• Treats anorexia, nausea and vomiting, cerebral edema, and inflammation.
• Common treatment for lymphomas, lymphocytic leukemias, and multiple myeloma.
• Beneficial in treating cancer signs and symptoms.

Inflammatory Bowel Disease

• Oral prednisone, 40 mg daily, is given to Crohn's patients until symptoms subside.
• Usually used when amino salicylates are ineffective or when symptoms are more severe in individuals experiencing ulcerative colitis.

Spinal Cord Injury

• Methylprednisolone may be effective in acute spinal cord injury at high doses if given within 8 hours of the injury.
• Methylprednisolone improves neurologic function; it does not improve mortality or result in normal neurologic function.
• Severe adverse outcomes including wound and systemic infections, GI hemorrhage, and pneumonia have been reported.

Contraindications

• In patients who experience allergic response to the medications.
• In patients with systemic fungal infections or systemic fungal diseases.
• Patients on corticosteroids should not receive live vaccines due to risk of contracting the virus.

Nursing Implications

• The patient should take the smallest effective dose for the shortest effective time.
• Dose must be tapered.
• Licorice can potentiate corticosteroids effects, so cautious use of licorice with corticosteroids is necessary.
• Assess patients for fainting, weakness, anorexia, nausea, vomiting, hypotension, and shock if adrenocortical insufficiency is suspected

Administration

• The oral route is preferred when these drugs must be given systemically.
• In acute situations, corticosteroids may be given at relatively large, divided doses for approximately 48 to 72 hours until the condition has been brought under control.
• In cases of chronic adrenocortical insufficiency, daily administration is needed.

Stress Dose Therapy

• Long-term use of pharmacologic doses of corticosteroids produces adverse reactions.
• For people receiving chronic corticosteroid therapy, dosage must be increased during periods of stress or illness.

Alternate-Day Therapy

• Double dose is taken every other morning.
• Schedule allows rest periods.
• This decreases adverse effects while anti-inflammatory effects continue.
• Can be started once symptoms have subsided and stabilized.
• It is not usually indicated in patients who have previously been treated with corticosteroids long-term.

An overview of corticosteroids, hormones produced in the adrenal cortex or gonadal organs to maintain homeostasis. Glucocorticoids, used for anti-inflammatory and anti-stress effects, are discussed along with indications for corticosteroid usage, such as respiratory and rheumatic disorders. Potential side effects, including decreased growth in children and increased risk of infection, are also outlined.