{"id":257,"date":"2019-11-14T20:40:55","date_gmt":"2019-11-15T01:40:55","guid":{"rendered":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/5-12-corticosteriods\/"},"modified":"2023-08-15T13:08:01","modified_gmt":"2023-08-15T17:08:01","slug":"5-12-corticosteriods","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/5-12-corticosteriods\/","title":{"raw":"5.12 Corticosteriods","rendered":"5.12 Corticosteriods"},"content":{"raw":"

Corticosteroids<\/h1>\r\nCorticosteroids 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.\r\n

Mechanism of Action<\/h2>\r\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 5.12-5.12b[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] for images of different formulations of fluticasone.\r\n\r\nOral prednisone prevents the release of substances in the body that cause inflammation. It also suppresses the immune system.\r\n\r\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 5.12c[footnote]\"Methylprednisolone vial.jpg<\/a>\" by Intropin<\/a> is licenced under CC BY 3.0<\/a>[\/footnote] for an image of methylprednisolone.\r\n

Indications for Use<\/h2>\r\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.\r\n

Nursing Considerations Across the Lifespan<\/h2>\r\nFluticasone is safe for children aged 4 years and older. Prednisone and methylprednisolone are safe for all ages. Watch for potential mood changes such as irritability and possible hyperactivity in children.\u00a0 Short term use can also lead to increase in blood pressure and blood sugar levels.\r\n

Adverse\/Side Effects<\/h2>\r\nFluticasone can cause hoarseness, dry mouth, cough, sore throat, and oropharyngeal candidiasis. Clients should rinse their mouths after use to prevent candidiasis (thrush).\r\n\r\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.<\/span>[footnote]Frandsen, G. & Pennington, S. (2018). Abrams\u2019 clinical drug: Rationales for nursing practice <\/em>(11th ed.). Wolters Kluwer.[\/footnote]<\/sup>\r\n\r\n[caption id=\"attachment_252\" align=\"aligncenter\" width=\"201\"]\"A Figure 5.12 Fluticasone Packaging[\/caption]\r\n\r\n[caption id=\"attachment_253\" align=\"aligncenter\" width=\"304\"]\"The Figure 5.12a Fluticasone oral inhaler formulation[\/caption]\r\n\r\n[caption id=\"attachment_254\" align=\"aligncenter\" width=\"300\"]\"A Figure 5.12b Fluticasone combination formulation[\/caption]\r\n\r\n[caption id=\"attachment_255\" align=\"aligncenter\" width=\"379\"]\"A Figure 5.12c Methylprednisolone requires reconstitution before administration[\/caption]\r\n

Client Teaching & Education<\/h2>\r\nClients 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 Clients 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]\r\n

Fluticasone Medication Card<\/h1>\r\nNow let's take a closer look at the medication card for fluticasone.[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]\r\n
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Medication Card 5.12.1: Fluticasone<\/h2>\r\n<\/header>\r\n
\r\n\r\nClass: <\/strong>Corticosteroids\r\n\r\nPrototypes:<\/strong> Fluticasone (Flovent)\r\n\r\nMechanism:\u00a0 <\/strong>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. Note that there are other corticosteroids that are used for more generalized inflammation such as oral prednisone and Methylprednisolone IV.\u00a0 These drugs have more of a systemic effect and are used at times for respiratory needs but mostly as a last resort.\u00a0 Fluticasone and other inhalers are preferred.\r\n

Therapeutic Effects<\/h3>\r\n