25.2 Corticosteroids
3 min read•june 18, 2024
are powerful anti-inflammatory drugs used to treat respiratory conditions like and COPD. They come in different forms, including inhalers, pills, and injections, each with its own benefits and potential side effects.
Nurses play a crucial role in administering these drugs and educating patients. They must assess breathing, teach proper inhaler use, monitor for side effects, and help patients understand the importance of following their treatment plan.
Corticosteroids in Respiratory Treatment
Key features of corticosteroids
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- Synthetic derivatives of natural hormones produced by the adrenal cortex mimic the effects of glucocorticoids, which have anti-inflammatory and immunosuppressive properties
- Available in various forms, including (ICS) for long-term control of asthma and COPD, for acute exacerbations and severe cases, and intravenous for hospitalized patients with severe exacerbations
- Commonly prescribed respiratory corticosteroids include , , , and mometasone (ICS), and prednisone and (oral and intravenous)
Therapeutic effects, side effects, and drug interactions
- Therapeutic effects reduce in the airways by inhibiting the production of inflammatory mediators, decrease airway hyperresponsiveness and mucus production, and prevent and control symptoms of asthma and COPD (wheezing, coughing, and shortness of breath)
- Side effects include local side effects ( or thrush, hoarseness, and throat irritation) more common with ICS, and systemic side effects (, fluid retention, weight gain, and mood changes) more common with oral and intravenous corticosteroids, with long-term use potentially leading to , , and increased risk of infections
- Drug interactions with inhibitors (, ) may increase corticosteroid levels and side effects, and concomitant use with may increase the risk of gastrointestinal side effects
Nursing considerations
- Assess the patient's respiratory status, including symptoms, rate (PEFR), and oxygen saturation
- Ensure proper inhaler technique when administering ICS by shaking the inhaler well before use and priming if necessary, instructing the patient to exhale fully, place the inhaler mouthpiece in the mouth, and inhale slowly and deeply, and encouraging the patient to hold their breath for 5-10 seconds after inhalation and rinse their mouth with water to prevent oral thrush
- Monitor blood glucose levels in patients receiving oral or intravenous corticosteroids, especially those with diabetes, and assess for signs of infection, as corticosteroids may mask symptoms and delay diagnosis
- Taper oral and intravenous corticosteroids gradually as directed to prevent and educate patients on the importance of regular follow-up with their healthcare provider
Patient education plan
- Explain the purpose and benefits of respiratory corticosteroids in managing asthma and COPD and demonstrate proper inhaler technique, emphasizing the importance of consistent use as prescribed
- Instruct patients to rinse their mouth with water after using ICS to prevent oral thrush and advise them to report any signs of infection (fever, chills, or persistent cough) to their healthcare provider
- Encourage patients receiving oral or intravenous corticosteroids to follow a balanced diet and engage in regular exercise to manage weight gain and maintain bone health, monitor blood glucose levels if diabetic and report any significant changes
- Stress the importance of regular follow-up appointments to assess treatment effectiveness and monitor for side effects, and provide written materials or resources for additional information and support (patient support groups or reliable online sources)
Key Terms to Review (59)
Acute Respiratory Distress Syndrome: Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by widespread inflammation in the lungs, leading to fluid buildup and impaired gas exchange. It is a critical complication that can arise in the context of various underlying medical conditions, including sepsis, pneumonia, and trauma.
Adhesion Molecules: Adhesion molecules are cell surface proteins that facilitate the attachment and interaction between cells, as well as between cells and the extracellular matrix. They play a crucial role in various physiological and pathological processes, including immune response, inflammation, and cell migration.
Adrenal Glands: The adrenal glands are a pair of endocrine glands located on top of the kidneys. They are responsible for the production and secretion of various hormones that play crucial roles in the body's stress response, metabolism, and other physiological processes, particularly in the context of corticosteroids.
Adrenal insufficiency: Adrenal insufficiency is a condition where the adrenal glands do not produce adequate amounts of steroid hormones, primarily cortisol. It can impact various bodily functions, including stress response and inflammation control.
Adrenal Insufficiency: Adrenal insufficiency is a condition in which the adrenal glands, located on top of the kidneys, do not produce enough of the essential hormones cortisol and aldosterone. This hormonal imbalance can have significant impacts on the body's ability to maintain proper osmolality, regulate corticosteroid production, and balance glucocorticoid and mineralocorticoid levels.
Adrenal Suppression: Adrenal suppression is a condition where the adrenal glands, responsible for producing essential hormones like cortisol, become underactive due to prolonged use of corticosteroid medications. This can have significant implications for the body's inflammatory response and overall hormonal balance.
Allergic Rhinitis: Allergic rhinitis is a condition characterized by an inflammation of the nasal passages, typically caused by an allergic response to environmental triggers such as pollen, dust, or pet dander. It is a common upper respiratory condition that can significantly impact a person's quality of life.
Anaphylaxis: Anaphylaxis is a severe, life-threatening allergic reaction that can occur rapidly and requires immediate medical attention. It involves multiple organ systems and can lead to shock and death if not treated promptly.
Anaphylaxis: Anaphylaxis is a severe, whole-body allergic reaction that can be life-threatening. It occurs when the immune system overreacts to an allergen, triggering the rapid release of chemicals that cause widespread inflammation and impair breathing and blood circulation.
Asthma: Asthma is a chronic inflammatory disorder of the airways characterized by recurring episodes of breathlessness, wheezing, chest tightness, and coughing. It involves a complex interplay of airway inflammation, bronchial hyperresponsiveness, and airflow obstruction, which can significantly impact respiratory function and quality of life.
Beclomethasone: Beclomethasone is an inhaled corticosteroid used to prevent and control symptoms of asthma. It reduces inflammation in the airways, making breathing easier.
Beclovent: Beclovent is a brand name for beclomethasone dipropionate, a corticosteroid inhaler used to prevent and control symptoms of asthma by reducing inflammation in the airways. It is not intended for immediate relief of acute bronchospasm.
Budesonide: Budesonide is a corticosteroid used to reduce inflammation in the airways of the lungs. It is commonly prescribed for conditions like asthma and chronic obstructive pulmonary disease (COPD).
Candidiasis: Candidiasis is a fungal infection caused by Candida species, commonly Candida albicans. It can occur in various parts of the body including the mouth, throat, and lungs.
Chemokines: Chemokines are a family of small, secreted proteins that play a crucial role in the inflammatory response and the regulation of immune cell trafficking. They function as chemoattractants, guiding the movement and activation of specific immune cells to sites of inflammation or infection.
Chronic Obstructive Pulmonary Disease: Chronic obstructive pulmonary disease (COPD) is a progressive lung condition characterized by persistent airflow obstruction, typically caused by a combination of small airway disease and parenchymal destruction. This term is important in the context of antitussives and corticosteroids, as these pharmacological interventions play a crucial role in the management of COPD symptoms and disease progression.
Corticosteroids: Corticosteroids are synthetic drugs that mimic the effects of hormones produced by the adrenal cortex, primarily cortisol. They are used to reduce inflammation and suppress the immune system in various medical conditions.
Corticosteroids: Corticosteroids are a class of steroid hormones that are naturally produced in the adrenal glands or synthetically created to mimic their effects. They play a crucial role in regulating various physiological processes, including inflammation, immune response, and metabolism, making them an important therapeutic tool in the context of several medical conditions.
Cushing's Syndrome: Cushing's syndrome is a hormonal disorder caused by excessive levels of the hormone cortisol in the body. It can lead to a variety of symptoms, including weight gain, high blood pressure, and diabetes, and is often associated with the long-term use of corticosteroid medications or the presence of an adrenal or pituitary gland tumor.
CYP3A4: CYP3A4 is a member of the cytochrome P450 enzyme family, which is responsible for the metabolism and biotransformation of a wide variety of drugs and other xenobiotics in the body. This enzyme plays a crucial role in the pharmacokinetics of many medications, influencing their absorption, distribution, and elimination.
Cytokines: Cytokines are small signaling proteins secreted by various cells in the body, particularly immune cells, that play a crucial role in regulating the immune response, inflammation, and other physiological processes. They act as chemical messengers, allowing cells to communicate with each other and coordinate their activities.
Deltasone: Deltasone is a brand name for prednisone, a synthetic corticosteroid drug used to reduce inflammation and suppress the immune system. It is commonly prescribed for conditions such as asthma, allergic reactions, and adrenal insufficiency.
Eosinophils: Eosinophils are a type of white blood cell that play a crucial role in the body's immune response, particularly in the context of allergic reactions and parasitic infections. They are characterized by their distinctive bilobed nucleus and bright red-orange granules within their cytoplasm.
FEV1: FEV1, or Forced Expiratory Volume in 1 second, is a pulmonary function test that measures the volume of air a person can forcibly exhale in the first second of a forced exhalation. It is a crucial metric used to assess lung function and diagnose respiratory conditions, particularly in the context of corticosteroid therapy.
Flovent HFA: Flovent HFA is an inhaled corticosteroid used to prevent asthma attacks. It helps reduce inflammation in the airways, improving breathing over time.
Fluticasone: Fluticasone is a synthetic corticosteroid used to reduce inflammation in the airways, commonly prescribed for asthma and chronic obstructive pulmonary disease (COPD). It works by inhibiting multiple types of inflammatory cells and decreasing the production of mediators involved in the inflammatory response.
Glucocorticoid Receptors: Glucocorticoid receptors are intracellular receptors that bind to and mediate the effects of glucocorticoid hormones, such as cortisol, within target cells. These receptors play a crucial role in regulating various physiological processes, including metabolism, immune function, and stress response.
Hyperglycemia: Hyperglycemia refers to an abnormally high level of glucose in the bloodstream. It is a key feature in the pathophysiology of various medical conditions, particularly diabetes mellitus, and can have significant implications for fluid and electrolyte balance, inflammatory processes, and overall health.
Hypothalamic-Pituitary-Adrenal Axis: The hypothalamic-pituitary-adrenal (HPA) axis is a complex neuroendocrine system that regulates the body's response to stress. It involves the coordinated actions of the hypothalamus, pituitary gland, and adrenal glands to maintain homeostasis and coordinate the physiological and behavioral responses to stressful stimuli.
Idiopathic Pulmonary Fibrosis: Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive lung disease characterized by the scarring and stiffening of the lung tissue, leading to impaired breathing and oxygen transfer. It is called 'idiopathic' because the exact cause of the condition is unknown.
IL-10: IL-10, or Interleukin-10, is a cytokine that plays a crucial role in the regulation of the immune response. It is primarily produced by monocytes, T cells, and B cells, and acts as an anti-inflammatory agent, helping to control and dampen the body's inflammatory reactions.
Immunosuppression: Immunosuppression refers to the reduction or inhibition of the immune system's ability to respond to foreign substances or pathogens. This process is essential in the context of inflammatory responses and the use of corticosteroids, as it can help manage excessive or inappropriate immune reactions.
Inflammation: Inflammation is the body's natural immune response to various stimuli, such as pathogens, damaged cells, or irritants. It is a complex biological process that aims to remove harmful stimuli, initiate the healing process, and restore homeostasis. Inflammation is a key component in the understanding of immunity, immunosuppressants, corticosteroids, and other related pharmacological topics.
Inhaled Corticosteroids: Inhaled corticosteroids are a class of medications used to manage and control inflammatory respiratory conditions, such as asthma and chronic obstructive pulmonary disease (COPD). These medications are administered directly into the lungs through inhalation, allowing for targeted delivery to the affected areas and minimizing systemic side effects.
Interstitial Lung Diseases: Interstitial lung diseases (ILDs) are a group of disorders that cause inflammation and scarring in the interstitium, the tissue between the air sacs (alveoli) in the lungs. This can lead to impaired gas exchange and reduced lung function. ILDs are particularly relevant in the context of corticosteroid therapy, as these medications can play a role in both the management and potential exacerbation of certain ILD subtypes.
Ketoconazole: Ketoconazole is a broad-spectrum antifungal medication used to treat a variety of fungal infections. It works by disrupting the synthesis of ergosterol, a critical component of the fungal cell membrane, thereby inhibiting the growth and proliferation of fungal organisms.
Lipocortin-1: Lipocortin-1, also known as annexin A1, is a protein that plays a crucial role in the anti-inflammatory effects of corticosteroids. It is a member of the annexin family of calcium-dependent phospholipid-binding proteins and is involved in various cellular processes, including the regulation of inflammation, cell signaling, and apoptosis.
Mast Cells: Mast cells are immune cells that play a crucial role in the body's inflammatory and allergic responses. They are found in various tissues, particularly those exposed to the external environment, and are known for their ability to release a variety of potent chemical mediators upon activation.
Medrol: Medrol is a brand name for methylprednisolone, a glucocorticoid used to reduce inflammation and suppress the immune system. It is commonly prescribed for conditions involving severe allergies, skin disorders, and endocrine disturbances.
Methylprednisolone: Methylprednisolone is a synthetic corticosteroid used to reduce inflammation and suppress the immune response. It is commonly administered for conditions like asthma, allergic reactions, and certain dermatologic disorders.
Moon Face: Moon face, also known as Cushingoid facies, is a physical characteristic associated with prolonged exposure to high levels of corticosteroids. It is characterized by a rounded, full, and puffy appearance of the face, giving it a moon-like shape.
Nirmatrelvir/ritonavir: Nirmatrelvir/ritonavir is a combination antiviral medication used to treat COVID-19. Nirmatrelvir inhibits a key viral protease, while ritonavir boosts its effectiveness by inhibiting metabolic degradation.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of medications that reduce inflammation, pain, and fever by inhibiting the production of prostaglandins, which are involved in the inflammatory response. They are a widely used group of drugs that differ from corticosteroids, which are a separate class of anti-inflammatory medications.
Oral Candidiasis: Oral candidiasis, also known as thrush, is a fungal infection that occurs in the mouth and is caused by an overgrowth of the Candida fungus, typically Candida albicans. It is a common opportunistic infection that can affect individuals with weakened immune systems or certain medical conditions.
Oral Corticosteroids: Oral corticosteroids are a class of synthetic steroid hormones that are taken by mouth to treat a variety of inflammatory and autoimmune conditions. They work by mimicking the effects of natural glucocorticoid hormones produced by the adrenal glands, which help regulate the body's immune response and inflammatory processes.
Osteoporosis: Osteoporosis is a condition characterized by weakened bones and an increased risk of fractures. It results from an imbalance between bone resorption and bone formation.
Osteoporosis: Osteoporosis is a progressive bone disease characterized by a decrease in bone mass and density, leading to an increased risk of fractures. This condition affects the structural integrity of bones, making them more fragile and susceptible to breaks, especially in the hips, spine, and wrists.
Peak Expiratory Flow: Peak expiratory flow (PEF) is a measurement of the maximum rate of airflow that can be generated during a forceful exhalation, starting from a position of full inspiration. It is a key indicator of lung function and can be used to monitor and manage respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD).
Pneumonia: Pneumonia is an inflammatory condition of the lungs, typically caused by an infection, that leads to the alveoli (air sacs) becoming filled with fluid or pus. This impairs the lungs' ability to take in oxygen and expel carbon dioxide, resulting in respiratory symptoms and potentially life-threatening complications.
Prednicot: Prednicot is a brand name for prednisone, a corticosteroid used to reduce inflammation in the treatment of lower respiratory disorders. It works by suppressing the immune system to decrease swelling and allergic reactions.
Pulmicort: Pulmicort is a brand name for budesonide, a corticosteroid used to manage and prevent asthma symptoms. It works by reducing inflammation in the airways.
Qvar: Qvar is a brand name for beclomethasone dipropionate, an inhaled corticosteroid used to manage and prevent symptoms of asthma. It works by reducing inflammation in the airways.
Ritonavir: Ritonavir is a protease inhibitor medication primarily used in the treatment of HIV/AIDS and as a pharmacokinetic enhancer for other antiviral drugs. It works by inhibiting the breakdown of these medications, allowing them to remain active in the body for longer periods.
Sarcoidosis: Sarcoidosis is a rare, inflammatory condition characterized by the formation of granulomas, which are collections of immune cells, in various organs of the body. This disease can affect multiple systems, including the lungs, skin, and lymph nodes, and is often associated with corticosteroid treatment.
Solumedrol: Solumedrol is a brand name for methylprednisolone, a corticosteroid used to reduce inflammation in various conditions including lower respiratory disorders. It is commonly administered intravenously or orally.
Sterapred: Sterapred is a brand name for prednisone, a synthetic corticosteroid used to reduce inflammation in conditions affecting the lower respiratory tract. It works by suppressing the immune response and decreasing inflammatory reactions.
Steroid Hormone Synthesis: Steroid hormone synthesis is the process by which the body produces various steroid hormones, such as cortisol, aldosterone, and sex hormones like estrogen and testosterone. This complex biochemical pathway involves a series of enzymatic reactions that convert cholesterol into these biologically active compounds, which play crucial roles in regulating a wide range of physiological processes in the body.
Striae: Striae, also known as stretch marks, are linear scarring that develops on the skin as a result of rapid stretching or shrinking of the skin. They are a common occurrence associated with various physiological and pathological conditions.
T-lymphocytes: T-lymphocytes, also known as T-cells, are a type of white blood cell that play a crucial role in the adaptive immune response. They are responsible for cell-mediated immunity, recognizing and destroying infected or cancerous cells, as well as regulating the overall immune system.