Glucocorticosteroids
Download
Report
Transcript Glucocorticosteroids
Corticosteroids /
Glucocorticoids
Endocrine and Non-Endocrine
Uses
Specific Drugs
Prednisone (Deltasone)
Methylprednisolone (Solumedrol IM/IV)
Cortisone
Betamethasone (Diprolene)
Dexamethasone (Decadron)
Hydrocortisone (Solucortef IM/IV)
Prednisolone
Triamcinolone (Azmacort, Nasacort, Kenalog)
Fluticasone (Flovent, Flonase, Advair*)
Budesonide (Pulmicort, Rhinocort, Symbicort*)
* Combination product
Indications
Replacement; Addison’s disease (low dose)
Non-endocrine (high dose)
Rheumatoid arthritis / SLE / other inflammation (po,
intra-articular injection)
Asthma (oral, inhaled, IV)
Inflammatory bowel disease
Allergic responses
Dermatologic (topical, oral)
Cancers
Organ transplant (immune system suppression)
Respiratory support in preterm infants
Decrease cerebral edema (suppress inflammation)
Actions
Background/overview
Metabolism
Mineralocorticoid effect (sodium retention)
Anti-inflammatory
Immunosuppressant
Adverse Effects
Adrenal insufficiency
Osteoporosis
Infection
Glucose intolerance
Muscle wasting
Fluid and electrolyte
imbalance
Edema, HTN, muscle
weakness,
dysrhythmias
Growth suppression
Depression/suicide
“roid rage”
Cataracts, glaucoma
Peptic ulcer
Iatrogenic Cushing’s
syndrome (classic
signs)
Thin skin
Drug Interactions
Digoxin, thiazide / loop diuretics due to
hypokalemia
NSAIDs due to GI bleeding
Insulin and oral hypoglycemics due to
hyperglycemia
Vaccines due to immunosuppression
No
live vaccines
Adrenal Suppression
Need for additional doses during stress if
replacement
Tapering if not replacement
DO
NOT ABRUPTLY STOP (with exceptions)
Alternate day dosing
Theoretically
there is less endogenous
corticosteroid suppression (via feedback)
Potency of Topical Corticosteroids
Potency can vary greatly between various
drugs, preparations (cream vs. ointment),
and routes of administration
Systemic absorption also varies based on
route
Ex.
Topical cream/ointment will have greater
systemic effect if skin broken vs. intact
See table for comparison of potency
Nursing Implications
Give with food
Give before 9 am to mimic circadian
rhythm
Contraindicated if systemic fungal
infection
Caution with pregnancy or lactation, HTN,
heart disease, renal failure, GI irritation,
DM