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. 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

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