5.12 Corticosteriods

Corticosteroids can be prescribed in a variety of routes. Fluticasone is an example of a commonly used inhaled corticosteroid; prednisone is an example of a commonly used oral corticosteroid; and methylprednisolone is a commonly used IV corticosteroid. Additional information about corticosteroids and potential adrenal effects is located in the “Endocrine” chapter.

Mechanism of Action

Fluticasone is a locally acting anti-inflammatory and immune modifier. The nasal spray is used for allergies, and the oral inhaler is used for long-term control of asthma. Fluticasone is also used in a combination product with salmeterol. It decreases the frequency and severity of asthma attacks and improves overall asthma symptoms. See Figures 5.14-16[1],[2],[3] for images of different formulations of fluticasone.

Oral prednisone prevents the release of substances in the body that cause inflammation. It also suppresses the immune system.

Methylprednisolone IV prevents the release of substances in the body that cause inflammation. It also suppresses the immune system. Methylprednisolone requires reconstitution before administration. See Figure 5.17[4] for an image of methylprednisolone.

Indications for Use

Fluticasone inhalers are used to prevent asthma attacks.  In respiratory conditions, oral prednisone is used to control severe or incapacitating allergic conditions that are unresponsive to adequate trials of conventional treatment for seasonal or perennial allergic rhinitis, bronchial asthma, contact dermatitis, atopic dermatitis, serum sickness, and drug hypersensitivity reactions. Methylprednisolone IV is used to rapidly control these same conditions.

Nursing Considerations Across the Lifespan

Fluticasone is safe for 4 years and older. Prednisone and methylprednisolone are safe for all ages.

Adverse/Side Effects

Fluticasone can cause hoarseness, dry mouth, cough, sore throat, and oropharyngeal candidiasis. Patients should rinse their mouths after use to prevent candidiasis (thrush).

Prednisone and methylprednisolone:  See more information about adverse effects of corticosteroids in the “Endocrine” chapter. Cardiovascular symptoms can include fluid retention, edema, and hypertension. Imbalances such as  hypernatremia (↑Na),  hypokalemia (↓ K+), and increased blood glucose with associated weight gain can occur. CNS symptoms include mood swings and euphoria. GI symptoms can include nausea, vomiting, and GI bleed.  In long- term therapy, bone resorption occurs, which increases the risk for fractures; the skin may bruise easily and become paper thin; wound healing is delayed; infections can be masked; and the risk for infection increases.  Long-term corticosteroid therapy should never be stopped abruptly because adrenal insufficiency may occur.[5]

Photo of Fluticasone nasal spray and package
Figure 5.14 Fluticasone nasal spray formulation
photo of inhaler for delivery of Fluticasone
Figure 5.15 Fluticasone oral inhaler formulation
Photo of hand holding a AdVair brand powder inhaler
Figure 5.16 Fluticasone combination formulation
Photo of a vial of methylprednisolone
Figure 5.17 Methylprednisolone requires reconstitution before administration

Patient Teaching & Education

Patients should be advised that corticosteroids are not used to treat an acute asthma attack.  They can cause immunosuppression and suppress signs of infection.  Corticosteroids can also cause an increase in blood glucose levels.  Patients may experience weight gain, swelling, increased fatigue, bruising, and behavioral changes.  These occurrences should be reported to one’s healthcare provider.[6]

Now let’s take a closer look at the medication grid for fluticasone, prednisone, and methylprednisolone in Table 5.12.[7],[8],[9]

Table 5.12 Fluticasone, Prednisone, and Methylprednisolone Medication Grid

Class/Subclass
Prototype/Generic
Administration Considerations
Therapeutic Effects
Adverse/Side Effects
Corticosteroids fluticasone Rinse mouth after use

Do not use as a “rescue” medication

Nasal spray: Used for management of the nasal symptoms of perennial nonallergic rhinitis

Inhaler: Used to improve the control of asthma by reducing inflammation in the airways

Hoarseness, dry mouth, cough, sore throat, and oropharyngeal candidiasis
Corticosteroids prednisone Do not use if signs of a systemic infection

When using more than 10 days, the dose must be slowly tapered

May increase blood glucose levels

Used to control severe or incapacitating allergic or respiratory conditions CV: fluid retention, edema, and hypertension

Electrolytes: ↑Na, ↓K+, ↑Ca, ↑BG

CNS: mood swings and euphoria in high doses

GI: Nausea/Vomiting, GI bleed

MS: bone resorption

Skin: acne, paper thin, bruises, infections, and delayed healing

Weight gain

Adrenal suppression

Increased risk for infection and infections can be masked

Long-term use may result in Cushing’s syndrome

Corticosteroids methylprednisolone May increase blood glucose levels Used to rapidly control severe or incapacitating allergic or respiratory conditions, in sepsis to reduce systemic inflammation, and to treat adrenal insufficiency Same as prednisone

 


  1. "Fluticasone Propionate Nasal Spray" by _BuBBy_ is licensed under CC BY 2.0
  2. "Fluticasone.JPG" by James Heilman, MD is licensed under CC BY-SA 4.0
  3. "Asthmatic Control" by David Camerer is licensed under CC BY-NC-ND 2.0
  4. "Methylprednisolone vial.jpg" by Intropin is licenced under CC BY 3.0
  5. Frandsen, G. & Pennington, S. (2018). Abrams’ clinical drug: Rationales for nursing practice (11th ed.). Wolters Kluwer.
  6. uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral
  7. This work is a derivative of Pharmacology Notes: Nursing Implications for Clinical Practice by Gloria Velarde licensed under CC BY-NC-SA 4.0.
  8. Frandsen, G. & Pennington, S. (2018). Abrams’ clinical drug: Rationales for nursing practice (11th ed.). Wolters Kluwer.
  9. This work is a derivative of Daily Med by U.S. National Library of Medicine in the public domain.

License

Icon for the Creative Commons Attribution 4.0 International License

5.12 Corticosteriods by Nursing Pharmacology by Chippewa Valley Technical College is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted. is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

Share This Book