Glucocorticoids

Glucocorticoids Overview

• Definition: Glucocorticoids are medications that significantly suppress the immune system and decrease inflammation.

• Uses:

  • Inhaled glucocorticoids: Long-term management of chronic asthma and COPD.

  • Oral glucocorticoids: Short-term management post-exacerbation.

  • Parenteral formulations: Administered intravenously in emergencies.

Prototype and Other Medications

• Beclomethasone dipropionate: Administered as an inhalant.

• Prednisone: Administered orally.

• Fluticasone: Administered intranasally or inhaled.

• Budesonide: Administered nasally or by inhalation for allergic rhinitis.

Expected Pharmacologic Action

• Anti-inflammatory effects: Suppress inflammation by preventing the release of mediators (leukotrienes, prostaglandins, histamine).

• Action on white blood cells: Inhibits leukocytes and eosinophils, reducing inflammation and airway edema.

Adverse Drug Reactions

• Inhaled glucocorticoids:

  • Oral candidiasis (yeast infection).

  • Hoarseness and difficulty speaking.

• Oral glucocorticoids:

  • Adrenal insufficiency with long-term use.

  • Muscle wasting and bone demineralization (risk of osteoporosis).

  • Hyperglycemia, peptic ulcers, increased infection susceptibility.

  • Fluid and electrolyte imbalances (sodium retention, potassium loss).

• Nasal glucocorticoids:

  • Dry mucous membranes, epistaxis (nosebleeds), sore throat, headaches.

Interventions – Inhaled

• Administering inhaled glucocorticoids:

  • Attach a spacer to MDI to enhance delivery and minimize oral contact.

  • If oral candidiasis occurs, initiate antifungal therapy promptly.

Interventions – Oral

• Monitoring and management:

  • Monitor plasma levels for adrenal function suppression.

  • Prescribe the lowest effective dose or consider alternate-day dosing.

  • Use gastric protective measures (take with food).

  • Prefer acetaminophen over NSAIDs to reduce GI bleeding risk.

  • Monitor blood glucose levels for hyperglycemia.

  • Look for subtle infection signs (fatigue, tachycardia, discharge).

  • Monitor for sodium retention and potassium loss; initiate replacement if needed.

Interventions – Nasal

• Comfort measures:

  • Encourage fluids, throat lozenges, and humidified air to alleviate dryness.

  • Use acetaminophen for headaches.

Administration – Inhaled

• Guidelines:

  • Administer on a regular schedule, not as needed (PRN).

  • Use inhaled beta-agonist first before glucocorticoid inhalation.

Administration – Oral

• Protocol:

  • Short-term therapy: single or divided doses for 5-10 days.

  • For long-term: alternate-day dosing; taper gradually.

  • Monitor for adrenal crisis when tapering.

Administration – Nasal

• Recommendations:

  • Utilize nasal metered-dose spray; taper from initial high dose.

  • Allow 2-3 weeks for full therapeutic effects; use decongestant for blocked nares.

Client Instructions – Inhaled

• Counseling:

  • Use a spacer and rinse mouth after use to prevent candidiasis.

Client Instructions – Oral

• Education:

  • Discuss effects and importance of tapering doses and reducing side effects.

  • Encourage calcium and vitamin D intake for osteoporosis prevention.

  • Instruct on monitoring blood sugar and recognizing signs of electrolyte imbalance.

Client Instructions – Nasal

• Guidance:

  • Use a humidifier, increase fluid intake, and take lozenges.

  • Report persistent sore throat or headache unresponsive to treatment.

Contraindications and Precautions

• Cautions:

  • Monitor clients with peptic ulcer disease, diabetes, hypertension, or those on NSAIDs.

  • Be careful transitioning between systemic and inhaled corticosteroids.

Safety Alerts

• Precautions with treatments:

  • Avoid oral glucocorticoids for systemic fungal infections or after live virus vaccinations.

  • Monitor for manifestations of infection despite corticosteroid therapy.

Interactions

• Risky combinations:

  • Avoid potassium-depleting diuretics (e.g., furosemide) with glucocorticoids.

  • NSAIDs increase GI bleeding risk with glucocorticoids.

  • Insulin and oral hypoglycemic effects are reduced during glucocorticoid therapy.