Bone and joints GLUCOCORTICOIDS: PREDNISONE

medication to treat joints such as RA

GLUCOCORTICOIDS: PREDNISONE mecahnisnm of action

interrupts inflammatory and immune cascade

-suppress inflammation and normal immune response

-symptomatic relief of inflammation and pain, acts as NSAID since it affects histamine to inhibit certain functions of phagocytes and lymphocytes

-delay disease progression

Uses of this medication

• Slow/delay the worsening of the disease

• Short term therapy until long-acting DMARDs take effect

• Prevention of organ rejection

• Management of inflammatory bowel disease

Complications

• Risk of infection - Glucocorticoids suppress the normal immune response and mask the signs of inflammation.

      ◦ Patients are at risk for infection, which can be masked (e.g., fever or sore throat).

      ◦ Glucocorticoids are contraindicated in clients with serious viral, bacterial, or fungal infections.

• Osteoporosis - This is a risk associated with long-term use.

      ◦ Glucocorticoids decrease the absorption of calcium.

      ◦ This effect can lead to decreased bone density and an increased risk for vertebral compression fractures and other bone fractures

• Adrenal suppression -This occurs if the medication is used for longer than 10 days.

      ◦ If glucocorticoids are stopped abruptly, it can cause adrenal insufficiency.

      ◦ Manifestations of adrenal insufficiency include nausea, vomiting, hypotension, shortness of breath, confusion, and cardiovascular collapse (Cushing syndrome may result from long-term, high-dose therapy

Fluid retention -This involves the retention of sodium and water. Manifestations include weight gain, edema, and crackles in the lungs

GI discomfort- GI discomfort/ulceration.  ◦ Concurrent use of Glucocorticoids with NSAIDs increases the risk of GI ulceration.

Hyperglycemia-Glucocorticoids promote hyperglycemia. They promote this by inhibiting the effects of insulin and stimulating glucose production. If the client is diabetic, the dosage of oral hypoglycemics may need to be increased.

Hypokalemia-Prednisone promotes the renal excretion of potassium

Drug to drug interactions

• Diuretics as they promote potassium loss -Diuretics promote potassium loss, leading to an increased risk of hypokalemia when taken concurrently with glucocorticoids, glucocorticoids (prednisone) promote the renal excretion of potassium. Combined use of diuretics further exacerbates this loss

• Digoxin - Concurrent use with digoxin increases the risk of digoxin-induced dysrhythmias, The hypokalemia caused by prednisone (due to potassium loss) increases the risk for digoxin-induced dysrhythmias

• NSAIDs -Concurrent use of prednisone with NSAIDs increases the risk of GI ulceration

• Use extreme caution is client is diabetic-Glucocorticoids increase blood glucose levels, meaning clients with diabetes may need to have their dosage of oral hypoglycemics or insulin increased

Nursing Education

• Can be taken PO or as intra-articular (a joint injection)

• Take calcium supplements & vitamin D-Glucocorticoids decrease the absorption of calcium,when on prednisone to help counteract the osteoporosis risk associated with long-term use. Nursing actions recommend giving glucocorticoids and calcium at least 1 hour apart

• Must not stop med abruptly

• Herbal/Food Supplements (Licorice, St. John's Wort)-

  Licorice may potentiate the effect of corticosteroids. St. John's wort may decrease prednisone levels.

  These herbal interactions affect the metabolism and resulting concentration of the glucocorticoid in the body.