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Corticosteroids / Glucocorticoids

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

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Corticosteroids / Glucocorticoids

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  1. Corticosteroids / Glucocorticoids Endocrine and Non-Endocrine Uses

  2. 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

  3. 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)

  4. Actions • Background/overview • Metabolism • Mineralocorticoid effect (sodium retention) • Anti-inflammatory • Immunosuppressant

  5. 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 Adverse Effects

  6. 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

  7. 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)

  8. 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

  9. 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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