Corticosteroids: Indications, Adverse Effects, and Client Teaching PDF

**Corticosteroids** - refers to glucocorticoids, mineralocorticoids, androgenic sex hormones regulated by the hypothalamic-pituitary-adrenal axis and are synthesis as needed by the body. *"Stress occurs (e.g. inflammation, trauma) \--\> hypothalamus secretes corticotropin releasing hormone (CRH) \-...

**Corticosteroids** - refers to glucocorticoids, mineralocorticoids, androgenic sex hormones regulated by the hypothalamic-pituitary-adrenal axis and are synthesis as needed by the body. *"Stress occurs (e.g. inflammation, trauma) \--\> hypothalamus secretes corticotropin releasing hormone (CRH) \--\> CRH activates anterior pituitary to secrete Adrenal Corticotropic Hormone (ACTH) \--\> ACTH activates adrenal glands to secrete glucocorticoid hormone (cortisol)"* Accumulation of cortisol level leads to activate negative feedback mechanism to shut off the production and release of CRH and ACTH so that no more cortisol is released. **GLUCOCORTICOIDS** - steroid hormones that regulate metabolism and immune response **Functions of Glucocorticoids** - Suppression of inflammation - Suppression of bone formation - Promotes gluconeogenesis \--\> increases availability of glucose - **Increased gastric acid secretion** **Glucocorticoids are primarily used for their anti-inflammatory properties.** **Prefix: ***\"\--sone\" , \"\--lone\"* *Dexamethasone, hydrocortisone, Budesonide, Fluticasone* **Indications of Glucocorticoids** - **For chronic use: taken PO** - For chronic inflammation - Lack of glucocorticoids due to adrenal insufficiency - - Suppress immune system on Organ Transplantation to prevent rejection - Autoimmune conditions  - Systemic Lupus Erythematosus - Inflammatory Bowel Disease - Asthma/ COPD (inflamed airway/lungs) - Cerebral/ spinal cord edema from tumor - Allergic Reactions **[Acute Use]** **For acute use: percutaneous administration (e.g. injections)** - Allergic Reactions  - Sepsis - Status asthmaticus **[Adverse Effect]** - **Hyperglycemia and insulin resistance** Diabetes and hypokalemia - **Sepsis** -caused by immunity suppression and may mask existing infection - All fevers even low-grade fever should be investigated - **Swelling**: sodium retention and fluid retention \--\> weight gain and hypertension - **Bone and muscle weakness** \-- decreased bone formation which may lead to osteoporosis and muscle weakness, growth restriction in children. - **Stomach problems** - gastritis and ulcers - **Eyesight changes**- such as glaucoma and cataracts in long term use - **Weight gain** **[Serious effect:]** - **Sadness** -- mood swings/psychosis - **Cushing Syndrome characterized with** - wide round or moon shaped face - Cervical fat deposits - Truncal obesity - Fragile skin, bruising - Acne, hirsutism due to changes on androgen hormones **Client Teaching ** - Should the taken morning with food due to the following reason - Mimics the body\'s natural timing of cortisol secretion which usually occurs in the morning - Reduces adverse GI effects - Dose should be tapered. Reinforce teaching about **NOT STOPPING IT ABRUPTLY** to prevent acute adrenal crisis,  life threatening condition due to lack of enough cortisol. - Anticipate weight gain \-- always adhere with regular exercise - **Dietary changes**: high calcium and vit D, high potassium, low sodium - Report signs for blood glucose elevation - Avoid concurrent NSAIDS - Report visual changes - Reduce risk of infection by - Stay current with vaccinations except live-attenuated vaccines such as  influenza (nasal) spray, MMR (measles, mumps, rubella) vaccines - Avoid large crowds **Topical Glucocorticoids to reduce inflammation for** - Eczema - Psoriasis - Contact Dermatitis - Allergies - Insect Bites **Adverse Effects:** - **Acne** - **Stretch marks** - **Skin thinning** - avoid use on the face , groin, underarm, near eyes Avoid occlusive dressing unless prescribed. Occlusive dressing may increase the absorption leading to overdose. **Inhaled Glucocorticoids** - **Through Metered Dose Inhalers** to help medications deliver deep into the lungs. The spacer acts as a chamber to hold fine particles of the drugs in until the client is able to inhale all of the medication. This is helpful for clients who have trouble timing the inhalation. Once the inhaler is depressed, the client should take a big breath in and briefly hold. The spacer allows them to take another breathe in if they need to get the full dose.  - **Dry Powder inhaler** **Adverse Effect:** - **Oral candidiasis** - a fungal or yeast infection in the mouth that appears as white patches or sores on the tongue, mouth or throat. - ***Preventive measure: Rinsing the mouth after taking the medication*** - **Hoarseness **