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  Growth suppression
 Osteoporosis  Depression/suicide
 Infection  “roid rage”
 Glucose intolerance  Cataracts, glaucoma
 Muscle wasting  Peptic ulcer
 Fluid and electrolyte  Iatrogenic Cushing’s
imbalance syndrome (classic
 Edema, HTN, muscle signs)
weakness,  Thin skin
dysrhythmias
 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