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 