{"id":236,"date":"2019-11-14T20:40:55","date_gmt":"2019-11-14T20:40:55","guid":{"rendered":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/5-12-corticosteriods\/"},"modified":"2021-12-07T11:11:35","modified_gmt":"2021-12-07T11:11:35","slug":"5-12-corticosteriods","status":"publish","type":"chapter","link":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/5-12-corticosteriods\/","title":{"raw":"5.12 Corticosteriods","rendered":"5.12 Corticosteriods"},"content":{"raw":"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.\n\nMechanism of Action<\/strong>\n\nFluticasone 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[footnote]\"Fluticasone Propionate Nasal Spray<\/a>\" by _BuBBy_<\/a> is licensed under CC BY 2.0<\/a>[\/footnote],[footnote]\"Fluticasone.JPG<\/a>\" by James Heilman, MD<\/a> is licensed under CC BY-SA 4.0<\/a>[\/footnote],[footnote]\"Asthmatic Control<\/a>\" by David Camerer<\/a> is licensed under CC BY-NC-ND 2.0<\/a>[\/footnote]<\/sup> for images of different formulations of fluticasone.\n\nOral prednisone prevents the release of substances in the body that cause inflammation. It also suppresses the immune system.\n\nMethylprednisolone 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[footnote]\"Methylprednisolone vial.jpg<\/a>\" by Intropin<\/a> is licenced under CC BY 3.0<\/a>[\/footnote]<\/sup> for an image of methylprednisolone.\n\nIndications for Use<\/strong>\n\nFluticasone inhalers are used to prevent asthma attacks.\u00a0 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.\n\nNursing Considerations Across the Lifespan<\/strong>\n\nFluticasone is safe for 4 years and older. Prednisone and methylprednisolone are safe for all ages.\n\nAdverse\/Side Effects<\/strong>\n\nFluticasone can cause hoarseness, dry mouth, cough, sore throat, and oropharyngeal candidiasis. Patients should rinse their mouths after use to prevent candidiasis (thrush).\n\nPrednisone and methylprednisolone:\u00a0 See more information about adverse effects of corticosteroids in the \"Endocrine\" chapter. Cardiovascular symptoms can include fluid retention, edema, and hypertension. Imbalances such as\u00a0 hypernatremia (\u2191Na),\u00a0 hypokalemia (\u2193 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.\u00a0 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.\u00a0 Long-term corticosteroid therapy should never be stopped abruptly because adrenal insufficiency may occur.[footnote]Frandsen, G. & Pennington, S. (2018). Abrams\u2019 clinical drug: Rationales for nursing practice <\/em>(11th ed.). Wolters Kluwer.[\/footnote]<\/sup>\n\n[caption id=\"attachment_235\" align=\"aligncenter\" width=\"303\"]\"Photo Figure 5.14 Fluticasone nasal spray formulation[\/caption]\n\n[caption id=\"attachment_235\" align=\"aligncenter\" width=\"304\"]\"photo Figure 5.15 Fluticasone oral inhaler formulation[\/caption]\n\n[caption id=\"attachment_235\" align=\"aligncenter\" width=\"399\"]\"Photo Figure 5.16 Fluticasone combination formulation[\/caption]\n\n[caption id=\"attachment_235\" align=\"aligncenter\" width=\"379\"]\"Photo Figure 5.17 Methylprednisolone requires reconstitution before administration[\/caption]\n\nPatient Teaching & Education<\/strong>\n\nPatients should be advised that corticosteroids are not used to treat an acute asthma attack.\u00a0 They can cause immunosuppression and suppress signs of infection.\u00a0 Corticosteroids can also cause an increase in blood glucose levels.\u00a0 Patients may experience weight gain, swelling, increased fatigue, bruising, and behavioral changes.\u00a0 These occurrences should be reported to one\u2019s healthcare provider.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\n\nNow let's take a closer look at the medication grid for fluticasone, prednisone, and methylprednisolone in Table 5.12.[footnote]This work is a derivative of Pharmacology Notes: Nursing Implications for Clinical Practice<\/a> by Gloria Velarde<\/a> licensed under CC BY-NC-SA 4.0<\/a>.[\/footnote],[footnote]Frandsen, G. & Pennington, S. (2018). Abrams\u2019 clinical drug: Rationales for nursing practice <\/em>(11th ed.). Wolters Kluwer.[\/footnote],[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>.[\/footnote]<\/sup>\n\nTable 5.12 Fluticasone, Prednisone, and Methylprednisolone Medication Grid\n\n\n\n\n\n\n
\n
Class\/Subclass<\/strong><\/h5>\n<\/th>\n
\n
Prototype\/Generic<\/strong><\/h5>\n<\/th>\n
\n
Administration Considerations<\/strong><\/h5>\n<\/th>\n
\n
Therapeutic Effects<\/strong><\/h5>\n<\/th>\n
\n
Adverse\/Side Effects<\/strong><\/h5>\n<\/th>\n<\/tr>\n
Corticosteroids<\/th>\nfluticasone<\/a><\/td>\nRinse mouth after use\n\nDo not use as a \"rescue\" medication<\/td>\nNasal spray: Used for management of the nasal symptoms of perennial nonallergic rhinitis\n\nInhaler: Used to improve the control of asthma by reducing inflammation in the airways<\/td>\nHoarseness, dry mouth, cough, sore throat, and oropharyngeal candidiasis<\/td>\n<\/tr>\n
Corticosteroids<\/th>\nprednisone<\/a><\/td>\nDo not use if signs of a systemic infection\n\nWhen using more than 10 days, the dose must be slowly tapered\n\nMay increase blood glucose levels<\/td>\nUsed to control severe or incapacitating allergic or respiratory conditions<\/td>\nCV: fluid retention, edema, and hypertension\n\nElectrolytes: \u2191Na, \u2193K+, \u2191Ca, \u2191BG\n\nCNS: mood swings and euphoria in high doses\n\nGI: Nausea\/Vomiting, GI bleed\n\nMS: bone resorption\n\nSkin: acne, paper thin, bruises, infections, and delayed healing\n\nWeight gain\n\nAdrenal suppression\n\nIncreased risk for infection and infections can be masked\n\nLong-term use may result in Cushing's syndrome<\/td>\n<\/tr>\n
Corticosteroids<\/th>\nmethylprednisolone<\/a><\/td>\nMay increase blood glucose levels<\/td>\nUsed to rapidly control severe or incapacitating allergic or respiratory conditions, in sepsis to reduce systemic inflammation, and to treat adrenal insufficiency<\/td>\nSame as prednisone<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n ","rendered":"

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.<\/p>\n

Mechanism of Action<\/strong><\/p>\n

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]<\/sup><\/a>,[2]<\/sup><\/a>,[3]<\/sup><\/a><\/sup> for images of different formulations of fluticasone.<\/p>\n

Oral prednisone prevents the release of substances in the body that cause inflammation. It also suppresses the immune system.<\/p>\n

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]<\/sup><\/a><\/sup> for an image of methylprednisolone.<\/p>\n

Indications for Use<\/strong><\/p>\n

Fluticasone inhalers are used to prevent asthma attacks.\u00a0 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.<\/p>\n

Nursing Considerations Across the Lifespan<\/strong><\/p>\n

Fluticasone is safe for 4 years and older. Prednisone and methylprednisolone are safe for all ages.<\/p>\n

Adverse\/Side Effects<\/strong><\/p>\n

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

Prednisone and methylprednisolone:\u00a0 See more information about adverse effects of corticosteroids in the “Endocrine” chapter. Cardiovascular symptoms can include fluid retention, edema, and hypertension. Imbalances such as\u00a0 hypernatremia (\u2191Na),\u00a0 hypokalemia (\u2193 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.\u00a0 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.\u00a0 Long-term corticosteroid therapy should never be stopped abruptly because adrenal insufficiency may occur.[5]<\/sup><\/a><\/sup><\/p>\n

\"Photo
Figure 5.14 Fluticasone nasal spray formulation<\/figcaption><\/figure>\n
\"photo
Figure 5.15 Fluticasone oral inhaler formulation<\/figcaption><\/figure>\n
\"Photo
Figure 5.16 Fluticasone combination formulation<\/figcaption><\/figure>\n
\"Photo
Figure 5.17 Methylprednisolone requires reconstitution before administration<\/figcaption><\/figure>\n

Patient Teaching & Education<\/strong><\/p>\n

Patients should be advised that corticosteroids are not used to treat an acute asthma attack.\u00a0 They can cause immunosuppression and suppress signs of infection.\u00a0 Corticosteroids can also cause an increase in blood glucose levels.\u00a0 Patients may experience weight gain, swelling, increased fatigue, bruising, and behavioral changes.\u00a0 These occurrences should be reported to one\u2019s healthcare provider.[6]<\/sup><\/a><\/sup><\/p>\n

Now let’s take a closer look at the medication grid for fluticasone, prednisone, and methylprednisolone in Table 5.12.[7]<\/sup><\/a>,[8]<\/sup><\/a>,[9]<\/sup><\/a><\/sup><\/p>\n

Table 5.12 Fluticasone, Prednisone, and Methylprednisolone Medication Grid<\/p>\n\n\n\n\n\n\n
\n
Class\/Subclass<\/strong><\/h5>\n<\/th>\n
\n
Prototype\/Generic<\/strong><\/h5>\n<\/th>\n
\n
Administration Considerations<\/strong><\/h5>\n<\/th>\n
\n
Therapeutic Effects<\/strong><\/h5>\n<\/th>\n
\n
Adverse\/Side Effects<\/strong><\/h5>\n<\/th>\n<\/tr>\n
Corticosteroids<\/th>\nfluticasone<\/a><\/td>\nRinse mouth after use<\/p>\n

Do not use as a “rescue” medication<\/td>\n

Nasal spray: Used for management of the nasal symptoms of perennial nonallergic rhinitis<\/p>\n

Inhaler: Used to improve the control of asthma by reducing inflammation in the airways<\/td>\n

Hoarseness, dry mouth, cough, sore throat, and oropharyngeal candidiasis<\/td>\n<\/tr>\n
Corticosteroids<\/th>\nprednisone<\/a><\/td>\nDo not use if signs of a systemic infection<\/p>\n

When using more than 10 days, the dose must be slowly tapered<\/p>\n

May increase blood glucose levels<\/td>\n

Used to control severe or incapacitating allergic or respiratory conditions<\/td>\nCV: fluid retention, edema, and hypertension<\/p>\n

Electrolytes: \u2191Na, \u2193K+, \u2191Ca, \u2191BG<\/p>\n

CNS: mood swings and euphoria in high doses<\/p>\n

GI: Nausea\/Vomiting, GI bleed<\/p>\n

MS: bone resorption<\/p>\n

Skin: acne, paper thin, bruises, infections, and delayed healing<\/p>\n

Weight gain<\/p>\n

Adrenal suppression<\/p>\n

Increased risk for infection and infections can be masked<\/p>\n

Long-term use may result in Cushing’s syndrome<\/td>\n<\/tr>\n

Corticosteroids<\/th>\nmethylprednisolone<\/a><\/td>\nMay increase blood glucose levels<\/td>\nUsed to rapidly control severe or incapacitating allergic or respiratory conditions, in sepsis to reduce systemic inflammation, and to treat adrenal insufficiency<\/td>\nSame as prednisone<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

  1. \"Fluticasone Propionate Nasal Spray<\/a>\" by _BuBBy_<\/a> is licensed under CC BY 2.0<\/a> ↵<\/a><\/li>
  2. \"Fluticasone.JPG<\/a>\" by James Heilman, MD<\/a> is licensed under CC BY-SA 4.0<\/a> ↵<\/a><\/li>
  3. \"Asthmatic Control<\/a>\" by David Camerer<\/a> is licensed under CC BY-NC-ND 2.0<\/a> ↵<\/a><\/li>
  4. \"Methylprednisolone vial.jpg<\/a>\" by Intropin<\/a> is licenced under CC BY 3.0<\/a> ↵<\/a><\/li>
  5. Frandsen, G. & Pennington, S. (2018). Abrams\u2019 clinical drug: Rationales for nursing practice <\/em>(11th ed.). Wolters Kluwer. ↵<\/a><\/li>
  6. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
  7. This work is a derivative of Pharmacology Notes: Nursing Implications for Clinical Practice<\/a> by Gloria Velarde<\/a> licensed under CC BY-NC-SA 4.0<\/a>. ↵<\/a><\/li>
  8. Frandsen, G. & Pennington, S. (2018). Abrams\u2019 clinical drug: Rationales for nursing practice <\/em>(11th ed.). Wolters Kluwer. ↵<\/a><\/li>
  9. This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. ↵<\/a><\/li><\/ol><\/div>","protected":false},"author":2,"menu_order":12,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by"},"chapter-type":[49],"contributor":[],"license":[53],"class_list":["post-236","chapter","type-chapter","status-publish","hentry","chapter-type-numberless","license-cc-by"],"part":195,"_links":{"self":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/236","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/users\/2"}],"version-history":[{"count":1,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/236\/revisions"}],"predecessor-version":[{"id":237,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/236\/revisions\/237"}],"part":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/parts\/195"}],"metadata":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/236\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/media?parent=236"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapter-type?post=236"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/contributor?post=236"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/license?post=236"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}