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