Steroids

Question 1

What are the 2 subcategories of corticosteroids?

What do they do?

Answer 1

Corticosteroids

• Glucocorticoids (reduce inflammation and suppress immune system)
  -> Cortisol/Cortisone
• Mineralcorticoids: salt and water balance (blood pressure)

Question 2

Cortisol is an _________ glucocorticoid

Answer 2

endogenous

naturally made in the body

Question 3

What “organ” are cortisol produced by?

What is the function of cortisol?

Answer 3

• Produced by adrenal glands
• Helps body manage stress
  -> regulate metabolism (increase glucose)
  -> Suppress inflammation and immune response

Question 4

Know the two parts of the adrenal gland and what each part secretes

Answer 4

Adrenal Gland

• Adrenal Medulla
  -> Secrete: Catacholamines
• Adrenal Cortex
  -> Secrete: Glucocorticoid, minercorticoid, androgens, aldosterone

Question 5

How are steroids secreted?

Hint: Know the pathway

Answer 5

1. Body undergoes stress
2. Hypothalamus releases CRH
3. CRH stimulates anterior pituitary gland ➡ release ACTH
4. ACTH stimulates the adrenal cortex ➡ secrete cortisol (glucocorticoid)

Regulated via neg FB loop

Question 6

Why do HCP recommend taper dosing rather than immediately taking a patient off steroids?

Answer 6

1. Taking steroids will increase the concentration of steroids in the blood
2. Because there is so much, the hypothalamus will no longer secrete CRH and will eventually prevent the production of endogeous “steroids”
3. If a person suddenly goes OFF of their steroids, the body will have a very LOW concentration of steroids in the body because it will take TIME for the body systems to connect and work together again
4. Suddenly going off of steroids increases the risk of adrenal/addisonian crisis, where the body is unable to produce enough cortisol (helps adapt to stress) and body might go into shock

Question 7

What is the pharmacologic and therapeutic class for Prednisolone and Flucticasone?

What is the difference between these two drugs? (in terms of form)

Answer 7

Pharmacologic Class:

• Glucocorticoid
  (Corticosteroid)

Therapeutic Class:

• Immunosuppressant
• Antiinflammatory

Prenisolone Form

• Tablet and liquid form

Fluticasone Form

• Inhaler

Question 8

Both Prednisolone and Flucticasone are in the same class, so their MOA are the same. Describe their MOA

Answer 8

1. Binds to glucocorticoid receptors
2. “Turns off” gene expression that produce inflammatory proteins
3. ⬇ inflammation and ⬇ immune system

Question 9

What are the indications in which to give Prednisolone?

Answer 9

• Asthma
• Allergic reactions
• Autoimmune disease
  -> Lupus
  -> RA
• Adrenal gland issues
  -> Addison’s disease
• Inflammatory conditions
  -> IBS

Question 10

What are the indications in which to give Fluticasone?

Answer 10

works more on the lungs

• Asthma
• COPD
• Allergic rhinitis

Question 11

What are the therapeutic effects of Prednisolone and Fluticasone?

Know the slight difference with fluticasone

Answer 11

• ⬇ inflammation
• ⬇ immune system
  -> Calm down overreactive immune responses

fluticasone - decrease inflammation, esp in airways

Question 12

What are the side effects of Prednisolone and Fluticasone?

Answer 12

Side Effect

• Weight gain
  -> ⬆ appetite
  -> ⬆blood sugar
• Insomnia

Question 13

What are the adverse effects of Prednisolone and Fluticasone?

Know the one unique to flucitcasone

Answer 13

Adverse Effects

• Adrenal suppression
• ⬆ risk infection
• Osteoporosis
• GI ulcers/bleeding
• Glaucoma/Cataracts
  -> Senile cataracts that occurs in those >60
• Cushing syndrome
  -> Moon face, buffalo hump

Adverse Effects - Unique to Fluticasone

• Oral thrush (candidiasis)

Question 14

What are the contraindications of Prednisolone and Fluticasone?

Answer 14

Contraindications

• NSAIDs
  -> ⬆risk GI bleed
• Live vaccine
  -> ⬆ risk infection

Question 15

A patient on Prednisolone asks about what type of diet they should follow while on this drug. The nurse informs the patient they should increase their intake of…

Answer 15

Increase intake of:

• Calcium
• Vitamin D

Help pvt osteoporosis

Question 16

A patient on Fluticasone
asks if theres anything she should know when using this inhaler. The nurse should educate her regarding what?

Answer 16

Patient Education - Inhaler Specific

• Rinse mouth with water without swallowing to prevent oral thrush
  -> Rinsing helps remove lingering medication

Question 17

A patient on Fluticasone is told by the nurse that this medication can cause osteoporosis as an adverse effect. To prevent this from occuring, the nurse should educate the patient to:

Answer 17

• Implement weight-bearing exercises

Question 18

A patient who is on Prednisolone calls their nurse and states that they stopped their medication because they gained too much weight. What should the nurse inform the patient?

Answer 18

Patient Education - Medication

• DO NOT stop taking abruptly
  -> Slowly bring dose down and stop or may cause adrenal crisis

Question 19

Because Prednisolone and Fluticasone suppress the immune system, what type of education regarding health and wellness should the nurse inform the patient about?

Answer 19

Patient Education - Health and Wellness:

• Avoid crowds
  -> Increased risk for infection
• Notify physician of infection
  -> Fever 100.4+
  -> Weakness
  -> Malaise
• Hand Hygiene

Question 20

T/F: Prednisolone and Fluticasone can cause GI bleeds

Answer 20

True