Steroids and Diuretics

Steroids and Diuretics Overview

• Presenter: Brent Evans, MSN, RN, CNE

Reading Materials

• Steroids: Pages 421-431 of CV Text

• Diuretics: Pages 272-277 of CV Text

Steroids: Hormones from the Adrenal Cortex

Types of Hormones

• Androgens: Affect sexual characteristics.

• Mineralocorticoids:

  • Example: Aldosterone

  • Regulate sodium (Na) and water balance.

• Glucocorticoids:

  • Key glucocorticoid: Cortisol.

  • Raises blood sugar levels.

  • Known as corticosteroids.

Function and Effects of Glucocorticoids

• Natural Effects:

  • Released by adrenal glands.

  • At low doses: physiological effects.

  • At high doses: pharmacological effects.

• Synthesis and Metabolism:

  • Synthesizes glucose from the liver.

  • Stores glucose for energy use.

  • Breakdown of fat (lipolysis) to produce energy.

  • Decreases protein synthesis as part of stress response.

  • Increases red blood cell (RBC) production and oxygen levels.

Pharmacological Effects at Higher Doses

• Intensify physiological effects.

• Side effects include:

  • Hyperglycemia.

  • Increased infection risk.

  • Osteoporosis.

  • Increased appetite and irritability.

  • Insomnia and adrenal insufficiency.

  • Growth delays in children.

  • Adrenal crisis if not weaned off after prolonged use.

Prednisone: The Steroid Prototype

• Administration: Oral, can be given clinically or at home.

• Indications:

  • Suppresses inflammation and allergic/immune response.

  • Cancer palliation to shrink tumors and reduce surrounding inflammation.

  • Replacement therapy for adrenal insufficiency.

Different Types of Steroids

• Budesonide: Inhaled for asthma and COPD.

• Dexamethasone: Potent anti-inflammatory, given IV or orally.

• Hydrocortisone: Topical for inflammation, weaker steroid.

• Methylprednisolone: Strong anti-inflammatory for asthma/COPD emergencies, transitioned to prednisone later.

• Cortisone: Used for adrenal insufficiency and inflammation.

Administering Steroids

• Timing: Give in the morning with food (reduces gastric upset).

• Monitoring:

  • Will raise blood sugar levels.

  • Can affect mood/appetite, potential for irritability.

  • Requires careful weaning due to immunosuppressive effects.

Lifespan Considerations for Steroids

Pediatric Considerations

• Inhibits bone growth, sensitive dosage guidelines, careful use of topical steroids.

Pregnancy

• Teratogenic risks in animals, weigh risks and limit use.

Breastfeeding

• Avoid, risk of growth suppression and adrenal insufficiency.

Elderly

• Slower metabolism, higher risk of drug interactions and complications such as ulcers and osteoporosis.

Diuretics Overview

Mechanism of Action

• Primarily excrete sodium (Na); water follows sodium.

• High sodium intake leads to fluid retention.

Diuretic Classes

• Thiazides: For hypertension (HTN).

• Loops: For edema.

• Carbonic Anhydrase Inhibitors: Adjunctive therapy for specific conditions (increased intraocular pressure).

• Potassium-Sparing Diuretics: Preserve potassium levels.

• Osmotic Diuretics: Treat increased intracranial pressure or intraocular pressure, e.g. Mannitol.

Diuretic Indications

• Used for:

  • Hypertension.

  • Edema (heart failure and pulmonary).

  • Liver failure.

  • Decreasing intraocular and intracranial pressure.

Specific Diuretics

Thiazides

• Hydrochlorothiazide (HCTZ): Common antihypertensive, well-tolerated, risk of hypokalemia and gout.

  • Typical dosing: 12.5-25 mg PO.

Loop Diuretics

• Furosemide (Lasix): Available in oral or IV form, strong diuretic for heart failure.

  • Parameters: Monitor BP and potassium.

  • Common considerations: Administer IV at a maximum of 20 mg/min to avoid ototoxicity.

• Bumetanide and Torsemide: Stronger loop diuretics indicated for severe cases.

Potassium-Sparing Diuretics

• Spironolactone: Prevents potassium wasting, helps patients sensitive to potassium fluctuations.

Administration Considerations for Diuretics

• Timing: Administer as early in the day as possible.

• Monitor electrolytes for imbalances.

• Establish a toileting plan, especially for strong diuretics.

• Monitor for hypotension and daily weights.

Important Issues to Monitor

• Electrolyte Balance: Particularly potassium levels for digoxin use and risks for diuretic interactions.

• Ototoxicity: Risk with quick administration of loop diuretics.

• Renal Function: Consistent hydration and monitoring of renal parameters are essential.

Questions and Discussion Points

• Open floor for questions on steroids and diuretics.