Glucocorticoids: Types, Action & Reactions

• Glucocorticoids are medications that suppress the immune system and decrease inflammation.
• They are used for long-term management of chronic asthma and COPD (inhaled), short-term management of post-exacerbation manifestations (oral), and in emergent situations (parenteral/IV).

Prototype and Other Medications

• Prototype glucocorticoids include beclomethasone dipropionate (inhalant), prednisone (oral), fluticasone (intranasal or inhaled), and budesonide (nasal or inhaled).

Expected Pharmacologic Action

• Glucocorticoids suppress inflammation by preventing the release of leukotrienes, prostaglandins, and histamine.
• They also prevent the action of white blood cells like leukocytes and eosinophils, decreasing edema of the airways.

Adverse Drug Reactions

• Inhaled glucocorticoids can cause oral candidiasis, hoarseness, and difficulty speaking.
• Oral glucocorticoids can cause adrenal insufficiency (especially with long-term use), muscle wasting, bone demineralization (osteoporosis), hyperglycemia, peptic ulcer disease, increased susceptibility to infection, and fluid/electrolyte imbalances.
• Nasal glucocorticoids can cause dry mucous membranes, epistaxis, sore throat, and headaches.

Interventions – Inhaled

• Use a spacer with an MDI (metered dose inhaler) to increase medication delivery to the lungs and decrease contact with mouth tissues.
• Treat oral candidiasis with antifungal therapy.

Interventions – Oral

• Monitor plasma medication levels for adrenal function suppression.
• Prescribe the lowest effective dose or alternate-day dosing.
• Implement gastric protective measures like taking the medication with food or meals.
• Recommend acetaminophen instead of NSAIDs for pain relief.
• Monitor blood glucose for hyperglycemia, especially in diabetic clients.
• Observe for subtle manifestations of infection (sore throat, fatigue, tachycardia, discharge).
• Monitor for sodium retention/hypernatremia and potassium loss/hypokalemia.
• Assess for weight gain, edema, and generalized weakness as signs of electrolyte imbalance.

Interventions – Nasal

• Provide comfort measures for dry mucous membranes, epistaxis, or sore throat with fluids, throat lozenges, and humidified air.
• Administer acetaminophen for headaches.

Administration – Inhaled

• Administer inhaled glucocorticoids on a regular schedule, not PRN.
• Use a beta2-adrenergic agonist first to dilate airways before administering the inhaled glucocorticoid.

Administration – Oral

• Short-term oral glucocorticoid therapy is usually given in single or divided doses for 5 to 10 days.
• Long-term use involves alternate-day dosing to decrease adverse reactions and adrenal suppression.
• Taper the dose slowly to avoid adrenal crisis.
• Supplemental doses are needed in times of stress (illness/surgery).

Administration – Nasal

• Use a nasal metered-dose spray device.
• The initial dose is higher than the maintenance dose.
• Taper the medication gradually to the lowest effective dose.
• Full therapeutic effects may take 2 to 3 weeks.
• Use a nasal decongestant first if nares are blocked.

Client Instructions – Inhaled

• Use a spacer during administration.
• Rinse mouth and gargle after use to prevent oral candidiasis.

Client Instructions – Oral

• Understand the short- and long-term implications of taking oral glucocorticoids.
• Alternate-day dosing decreases side effects and adrenal gland suppression.
• Never stop these medications abruptly; the dose must be tapered to prevent adrenal insufficiency.
• Increase intake of calcium and vitamin D and perform weight-bearing exercises to prevent osteoporosis.
• Report polyphagia, polydipsia, or polyuria.
• Report weight gain, edema, or generalized weakness.

Safety Alert - Oral Glucocorticoids

• Take gastric-protective measures to prevent gastric ulcers.
• Avoid NSAIDs and use acetaminophen instead for mild pain.
• Take glucocorticoids with a snack or meal.
• Report vomiting blood or black, tarry stools immediately.

Safety Alert - Glucocorticoids

• Notify the provider at the first sign of infection.
• Typical manifestations may not be present.
• Look for sore throat, fatigue, tachycardia, wound drainage, or white patches.

Client Instructions – Nasal

• Use a humidifier, increase fluid intake, and suck on hard candy or lozenges.
• Notify the provider if a sore throat doesn't respond to therapy or is accompanied by fatigue.
• Take acetaminophen for headaches.

Contraindications and Precautions

• Use cautiously in clients with peptic ulcer disease, diabetes mellitus, hypertension, renal dysfunction, or if taking NSAIDs regularly.
• Be cautious when changing from systemic to inhaled corticosteroids.
• Monitor for adrenal insufficiency manifestations (nausea, weakness, fatigue, hypotension, hypoglycemia, abdominal pain, loss of appetite).

Safety Alert

• Avoid oral glucocorticoids in clients with systemic fungal infections or recent live virus immunization.
• Double-check that inhaled glucocorticoids were not prescribed in clients who have oral candidiasis.

Interactions

• Avoid giving with potassium-depleting diuretics.
• Use of NSAIDs increases the risk of gastrointestinal bleeding.
• Glucocorticoids decrease the effects of insulin and oral hypoglycemics.

Learn about glucocorticoids, medications used to suppress the immune system and decrease inflammation. This lesson covers prototypes like beclomethasone dipropionate and prednisone. It also explains their pharmacologic action and potential adverse drug reactions.