Corticosteroids: Functions and Uses

Overview of Corticosteroids

• Corticosteroids include glucocorticoids and mineralocorticoids
• These hormones are essential for life and influence many organs and structures in the body.

Functions of Corticosteroids

• Anti-inflammatory action: Reduces inflammation
• Blood pressure regulation: Increases blood pressure
• Metabolism: Affects carbohydrate, protein, and fat metabolism
• Immunosuppressant: Suppresses the immune system
• Stress Protection: Released during stressful situations
• CNS Responses: Increases mood

Therapeutic Uses of Corticosteroids

• Adrenal Cortical Insufficiency: Replacement therapy (e.g., fludrocortisone) can be used
• Allergic Reactions: Severe allergic responses can be treated
• Collagen Diseases: Conditions like lupus get treated
• Dermatologic Conditions: Treats rashes and skin-related issues
• Rheumatic Disorders: Management of rheumatic conditions
• Shock: Helps elevate blood pressure

Adverse Reactions and Side Effects

• Increased Glucose: Monitor diabetics closely
• Cushing's Syndrome causes:
  • Buffalo hump
  • Moon face
  • Oily skin and acne
  • Excess fat deposits on the trunk
  • Fat loss in legs and arms
  • Weight gain
  • Altered skin pigmentation
• Osteoporosis: Due to decreased calcium uptake
• Muscle Weakness/Cramping: Due to decreased potassium levels

Contraindications

• Active Infections: Avoid use in uncontrolled infections
• Immunosuppression: Can worsen infections

Drug Interactions

• Diuretics: Increased risk of hypokalemia, especially with loop and thiazide diuretics
• Digoxin: May cause digoxin toxicity
• Anti-diabetic Drugs/Insulin: Effectiveness can decrease
• Vaccines: Can decrease vaccine effectiveness, boosters may be needed

Pre-Administration Assessment

• Vital Signs: Monitor blood pressure closely
• Baseline Electrolytes: Check sodium, potassium, chloride, magnesium, calcium levels
• Glucose Levels: Check with a spot glucose check or hemoglobin A1c
• Hemoglobin A1c: Checks sugar levels over a 3-month period
• Assessment of Disease Involvement: Note signs and symptoms

Administration Routes

• IM: Intramuscular injection
• Subcutaneous: Injection under the skin
• IV: Intravenous injection
• Topical: Applied to the skin
• Inhalant: Inhaled (e.g., inhalers)
• Intraarticular: Injection into the joint
• Intralesional: Injection directly into a lesion

Ongoing Assessment and Monitoring

• Electrolyte Monitoring: Watch for imbalances
• EKG Monitoring: Assess for hypokalemia-related heart issues

Alternate Day Therapy

• Long-Term Therapy: Used to minimize adverse effects
• Dosage Schedule: Give twice daily on alternating days

Patient Education

• Never Skip a Dose: Important for consistent therapy
• Alternative Route: If unable to take orally, use injections
• Lifelong Therapy: Necessary for conditions like Addison's disease
• Timing of Dose: Administer before 9:00 a.m.
• Diabetic Monitoring: Monitor glucose levels frequently

Glucose Level Monitoring

• Frequency: Glucose levels are often checked four times a day (before meals and at bedtime)
• Trend Monitoring: Patients should be aware of upward trends in their glucose levels and promptly inform their healthcare provider
• Medication Adjustment: Awareness of glucose levels helps in timely adjustments to insulin or other medications

Corticosteroid Discontinuation and Adrenal Insufficiency

• Tapering: Corticosteroids should be "titrated down or tapered" to avoid adrenal insufficiency
• Adrenal Insufficiency: Sudden discontinuation can result in adrenal insufficiency, which can cause significant health issues

Administration and Timing

• Timing: Administer the medication early in the morning
• With Food: Taking corticosteroids with food or milk can help reduce gastrointestinal irritation

Wound Healing and Vaccinations

• Impaired Wound Healing: Wounds may heal more slowly than normal
• Vaccinations: Avoid vaccinations during therapy due to immunosuppression

Dietary Considerations

• Low Sodium: Helps manage fluid retention
• High Vitamin D: Supports bone health
• High Protein: Aids in maintaining muscle mass
• High Potassium: Helps balance electrolyte levels

Infection Risk and Monitoring

• Immunosuppression: Increases susceptibility to infections
• Signs of Infection: Monitor for signs such as a slight rise in temperature or sore throat
• Masking Infections: Can mask infections, so look for even subtle signs

Gastrointestinal and Fluid Balance Monitoring

• Epigastric Pain: Report any epigastric burning or pain
• Blood in Emesis/Stool: Look for bloody or coffee-ground emesis and tarry stools, which may indicate peptic ulcers
• Edema: Monitor for edema, indicating fluid volume excess
• Intake and Output: Accurate measurement is essential
• Daily Weights: Regular weight monitoring helps detect fluid retention
• Breath Sounds: Monitor breath sounds for signs of fluid overload

Topical Corticosteroids

• No Covering: Do not cover the treated area
• Avoid Sunlight: Protect the treated area from sunlight

Common Corticosteroid Names

• Generic Names: Often end in "–one"

Adrenocorticotropic Hormone (Corticotropin)

• Mechanism: Stimulates the adrenal cortex to produce glucocorticoids
• Uses: Managing acute exacerbations of multiple sclerosis, non-supportive thyroiditis, hypercalcemia associated with cancer
• Contraindications: Adrenal cortical insufficiency, allergy to pork products, systemic fungal infections, ocular herpes simplex, scleroderma, osteoporosis, or hypertension

Pre-Treatment Assessment for Corticotropin

• Weight and Skin Integrity: Assess baseline condition
• Lung Status: Monitor breath sounds
• Mental Status: Evaluate orientation (person, place, time)

Monitoring During Corticotropin Therapy

• Intake and Output: Accurate monitoring is crucial
• Blood Glucose: Monitor for hyperglycemia, especially in diabetic patients
• Bleeding: Check for tarry stools or bright red bleeding
• Administration Routes: Can be given IV, subcutaneously, or IM
• Allergic Reactions: Watch for allergic reactions for up to two hours after administration

Infection and Behavioral Changes

• Infection Signs: Look for slight rises in temperature, sore throat, and skin infections
• Injection Site Monitoring: Monitor injection sites for localized infection
• Behavioral Changes: Report any evidence of behavioral changes such as mental depression, insomnia, euphoria, mood swings, or nervousness

Communication and Awareness

• Family Involvement: Family members should be aware of potential behavioral changes
• Staff Awareness: Staff members should also be informed about what to look for

Anti-Diabetic Drugs: Insulin

• Source: Manufactured by beta cells in the pancreas