Corticosteroid Therapy - Exam 2 Flashcards
prednisone
Classification: hormone
Mechanism of Action: Oral synthetic adrenocorticosteriod
Use: Used in inflammatory conditions and as an immunosuppressant
Side/Adverse Effects: euphoria, insomnia, N/V, muscle weakness, delayed wound healing, osteoporosis, hypokalemia, glucose intolerance, growth suppression in children, Cushingoid features
Nursing Implications: administer with food or snack to avoid GI upset. Do not abruptly start or stop drug. Reduce dose gradually by scheduled regiment to prevent withdrawal symptoms and permit adrenals to recover from drug-induced partial atrophy. Monitor bone density. Be aware of masked infections and delayed wound healing. Monitor weight, BP, blood glucose levels
methylprenisolone (Solumedrol)
Classification: hormone
Mechanism of Action: IV synthetic adrenocorticosteroid
Use: anti-inflammatory agent in management of acute/chronic inflammatory diseases
Side/Adverse Effects: euphoria, insomina, N/V, muscle weakness, delayed wound healing, osteoporosis, hypokalemia, glucose intolerance, growth suppression in children, Cushingoid features.
Nursing Implications: monitor weight, BP. Monitor diabetics for loss of glycemic control, teach family to report slow wound healing, significant insomnia. Do not alter established dosage regimen. Report onset of hypocorticism adrenal insufficiency: fatigue, nausea, anorexia, joint pain, weakness
What are corticosterioids?
Man-made medications
Similar to cortisol, a hormone
Commonly called sterioids
Endogenous Corticosterioids
- Under the control of the hypothalamus-pituitary-adrenal (HPA) axis
- Normal controls
- Activation of stress reaction will also cause release of adrenocortical hormone from adrenal gland
Types of endogenous corticosterioids
- Glucocorticoids
- Mineralocorticoids
- Androgens
Glucocorticoids
- Regulate protein and fat metabolism
- Increase blood glucose/glucose utilization
- Buffers the stress response
- Alters immune function
- Reduces the inflammatory response
- Cortisol
Mineralocorticoids
- Regulate sodium, water and potassium balance
- Aldosterone
Androgens
- Contribute to growth and development
- Sexual activity in adult women
- Progesterone
- Testosterone in men (produced in the testes)
Action of Corticosterioid
- Anti-inflammatory
- Immunosuppresion
- Maintenance of normal BP
- Maintenance of normal glucose metabolism
Why are corticosteroids given?
- Treat inflammatory illnesses by decreasing the inflammatory response
- Decrease inflammation
- Redness
- Swelling
- Heat
- Pain
- Immunosuppression
- Hormone replacement in adrenocortical insufficiency (ex. Addison’s Disease)
- Antineoplastic
When a disease process has significant impact on the patient’s ability to function…corticosteroids are used. Corticosterioid use is based on individual patient characterisitics, they should be given locally if possible and in the smallest doses for the shortest duration needed.
Types of manufactured (exogenous) corticosteroid medications
- Inhaled (fluticasone)
- Ophthalmic eye drops
- Oral (prednisone)
- IM emergency kits for Addison’s patients
- IV (methylprednisolone)
- Topical (hydrocortisone cream)
Nursing Implications (monitor for therapeutic effect and adverse effects)
- Give in morning to mimic normal endogenous steroid release
- Give with food
- Do not stop aburptly
- Give smallest doses for shortest length of time to treat disease
Monitoring for side effects; too much steroid
- Change in behavior
- Insomnia/euphoria
- GI irritation
- Na and fluid retention
- Hypokalemia
- Hyperglycemia and CHO intolerance
- Weight gain
- Decreased ability to fight infection
- Slow wound healing
- Osteoporosis
Therapeutic Nursing Interventions
- Administer PO with meals
- Teach need to continue dose and taper. Do not abruptly discontinue
- Low Na diet
- Complex carbohydrates not simple sugars in diet
- Adequate Ca++ in diet, weight bearing exercise
- Vaccination for prevention of infection
- Planning/support for possible body image changes
- Medic-alert information
- Emotional Support
Long term exogenous coricosteroid effects
- Truncal obesity, hyperglycemia
- Moon face, hirsuitism, acne
- Thin skin, poor wound healing
- Sodium and water retention
- Hypokalemia
- GI ulcers
- Osteroporosis
- Fatigue/Mood swings
Assessments for patients on corticosteroids
- Temperature, s/s infection
- VS, espeically BP
- Fluid volume excess
- N/V, gastric upset
- Hyperglycemia/blood glucose monitoring
- Weight gain
- Assess wound healing
- Osteoporosis
- Mood changes/emotional effects
Cushing’s Disease
Excessive endogenous production of steroid by adrenal gland treatment - depends on specific reason for excess steroid
- Resection/radiation of pituitary adenoma
- Surgical removal of ACTH secreting tumors
- Adrenalectomy
- Medical suppression of adrenal function
- Correction of underlying cause followed by steroid replacement therapy
Reducing side effects of exogenous steroid therapy
- Reduction in dose - lowest dose that keeps symptoms aways
- Gradual tapering - when possible
- Conversion to alternate day regimen - allows pituitary to make some ACTH
Addison’s Disease
Too little corticosteroid
An autoimmune response that destorys the adrenal cortex
Sign and Symptoms:
- Weight loss
- Hypovolemia
- Hypotension
- Low Na, high K
- A/N/V/D
- Anemia/Fatigue
Addison’s Disease looks like situation when exogenous corticosteroids are abruptly stopped - known as Addison’s crisis. When steroid replacement is abruptly stopped, adrenals cannot produce steroids, can be life threatening.Hypotension and shock can result.
Nursing assessment:
- VS especially BP
- S/S fluid volume deficit
- GI distress/weight loss
- Anemia, Hct, fatigue
- Na, K
TNIs:
- Teach patient about life long need for replacement of steroids
- Need for ongoing medical supervision
- Extra steroids during times of stress
- Medic alert information
- Emergency kit use; 100mg IM hydrocortisone
