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*)
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* Combination product
Indications
Replacement; Addison’s disease (low dose)
 Non-endocrine (high dose)
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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)
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Actions
Background/overview
 Metabolism
 Mineralocorticoid effect (sodium retention)
 Anti-inflammatory
 Immunosuppressant
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Adverse Effects
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Adrenal insufficiency
Osteoporosis
Infection
Glucose intolerance
Muscle wasting
Fluid and electrolyte
imbalance
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Edema, HTN, muscle
weakness,
dysrhythmias
Growth suppression
 Depression/suicide
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“roid rage”
Cataracts, glaucoma
 Peptic ulcer
 Iatrogenic Cushing’s
syndrome (classic
signs)
 Thin skin
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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
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 No
live vaccines
Adrenal Suppression
Need for additional doses during stress if
replacement
 Tapering if not replacement
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 DO
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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
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 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
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