Glucocorticoids: Functions and Regulation

• Corticosteroids include glucocorticoids, mineralocorticoids, and androgenic sex hormones.
• These hormones are regulated by the hypothalamic-pituitary-adrenal axis.
• Synthesis of these hormones occurs as required by the body.
• Stress triggers the hypothalamus to release corticotropin releasing hormone (CRH).
• CRH stimulates the anterior pituitary to release Adrenal Corticotropic Hormone (ACTH).
• ACTH prompts the adrenal glands to secrete glucocorticoid hormone (cortisol).
• Elevated cortisol levels activate a negative feedback mechanism.
• This mechanism shuts off the production and release of CRH and ACTH, preventing further cortisol release.
• Glucocorticoids are steroid hormones involved in regulating metabolism and immune response.

Functions of Glucocorticoids

• Suppression of inflammation
• Suppression of bone formation
• Promotion of gluconeogenesis to increase glucose availability
• Increased gastric acid secretion
• Primarily used for anti-inflammatory properties
• Common prefixes in drug names: "-sone" or "-lone"
• Examples: Dexamethasone, hydrocortisone, Budesonide, Fluticasone

Indications for Glucocorticoids

• For chronic conditions, taken orally (PO)
• Chronic inflammation
• Adrenal insufficiency, such as Addison's Disease
• Suppression of the immune system to prevent organ transplant rejection
• Autoimmune conditions like Systemic Lupus Erythematosus and Inflammatory Bowel Disease
• Asthma and COPD to reduce airway inflammation
• Cerebral or spinal cord edema resulting from tumors
• Allergic reactions
• For acute conditions via percutaneous administration (e.g., injections)
• Allergic Reactions
• Sepsis
• Status asthmaticus

Adverse Effects

• Hyperglycemia and insulin resistance, potentially leading to diabetes and hypokalemia
• Sepsis is caused by immunity suppression and may mask existing infection.
• All fevers, even low-grade, should be investigated.
• Swelling from sodium and fluid retention leads to weight gain and hypertension.
• Bone and muscle weakness from decreased bone formation, potentially causing osteoporosis, muscle weakness, and growth restriction in children. Stomach problems, such as gastritis and ulcers
• Eyesight changes like glaucoma and cataracts can happen with long-term use. Serious effects include:
• Sadness and mood swings or psychosis
• Cushing Syndrome is characterized by a wide or moon-shaped face
• Cervical fat deposits
• Truncal obesity
• Fragile skin and bruising
• Acne and hirsutism occur due to changes in androgen hormones

Client Teaching

• Medication should be taken in the morning with food.
• This mimics the body's natural cortisol secretion pattern
• Taking with food reduces adverse GI effects
• Dose should be tapered to prevent acute adrenal crisis, which is life-threatening due to lack of cortisol.
• Anticipate weight gain and adhere to a regular exercise routine
• Dietary changes: high calcium and vitamin D, high potassium, and low sodium
• Report signs of elevated blood glucose
• Avoid concurrent NSAIDs
• Report visual changes
• Reduce the risk of infection
• Stay current with vaccinations, except for live-attenuated vaccines
• Avoid large crowds

Topical Glucocorticoids

• Used to reduce inflammation for eczema, psoriasis, contact dermatitis, allergies, and insect bites
• Acne is a potential adverse effect
• Stretch marks may occur
• Skin thinning - avoid use on the face, groin, underarm, near eyes.
• Avoid occlusive dressing unless prescribed, as it may increase absorption and lead to overdose

Inhaled Glucocorticoids

• Administered through Metered Dose Inhalers
• Medications deliver deep into the lungs.
• Spacers act as a chamber to hold fine particles of the drugs until inhalation.
• The spacer allows them to take more breath if they need to get the full dose.
• Dry Powder Inhalers

Adverse Effects

• Oral candidiasis is a fungal or yeast infection with white patches or sores on the tongue, the mouth and throat.
• Rinse mouth after taking the medication to prevent oral candidiasis
• Hoarseness