Class: Corticosteroids "Glucocorticoid therapy ' , anti inflammatory
Trade names: deltasone
Pregnancy: (Category C/ D if used in 1st trimester )
They are a group of natural hormones produced by the adrenal cortex.
- They are used for a variety of therapeutic purposes.
- Many slightly modified synthetic variants are available today.
- Some patients respond better to one substance than to another.
- These hormones influence many metabolic pathways & all organ systems & are essential for survival.
- The release of corticosteroids is controlled by hormones such as corticotropin- releasing factor produced by the hypothalamus & ACTH produced by the anterior pituitary.
- Replacement therapy : adrenal insufficiency (Addison’s disease) .
- Rheumatic disorders : rheumatoid arthritis & osteoarthritis.
- Collagen diseases: systemic lupus erythromatosus, rheumatic cardiac.
- Allergic diseases: drug hypersensitivity , urticarial transfusion reaction.
- Respiratory diseases: bronchial asthma , rhinitis.
- Ocular diseases : allergic & inflammatory conjunctivitis, keratitis
- Dermatological diseases: psoriasis, contact dermatitis, urticaria.
- Diseases of the GIT: ulcerative colitis.
- Nervous system : Myasthenia gravis.
- Malignancies: leukemia, lymphoma.
- Nephrotic syndrome.
- Hematologic diseases: hemolytic anemia, thrombocytopenic purpura.
- Miscellaneous: septic shock, liver cirrhosis, stimulation of surfactant
- production, prevention of organ rejection.
by mouth, initially, up to 10–20 mg daily (severe disease, up to 60 mg daily), preferably taken in the morning after breakfast; can often be reduced within a few days but may need to be continued for several weeks or months
Maintenance, usual range, 2.5–15 mg daily, but higher doses may be needed; cushingoid side-effects increasingly likely with doses above 7.5 mg daily
By intramuscular injection, prednisolone acetate, 25–100 mg once or twice weekly
- If infection is suspected (Mask signs & symptoms).
- Peptic ulcer.
- Acute glomerulonephritis.
- Cushing’s syndrome .
- Congestive heart failure.
Prolonged therapy may cause Cushing-like syndrome & atrophy of the adrenal cortex & subsequent adrenocortical insufficiency.
Steroid withdrawal syndrome may lead to : anorexia, nausea, vomiting, weight loss , headache , myalgia & hypotension.
Side effects include:
Edema, alkalosis, hypokalemia, hypertension, CHF muscle wasting , weakness, osteoporosis, nausea & vomiting.
Headache , hypercholesterolemia , hirsutism, amenorrhea, depression.
Redistribution of body fats: thin extremities and fat trunk, moon-like face, buffalo hump.
- Administer oral forms with food to minimize ulcerogenic effect.
- For chronic use, give the smallest dose possible.
- Corticosteroids should be discontinued gradually if used chronically.
- Document baseline weight , B.P. , Pulse & temperature.
- Frequently take BP, monitor body weight (signs of Na+ & H2O retention).
- Periodic serum electrolytes, blood sugar monitoring.
- Report signs & symptoms of side effects (cushing-like syndrome).
- Discuss with female client potentials of menstrual difficulties.
- Instruct the client to take diet high in protein & potassium.
- Instruct the client to avoid falls & accidents (osteoporosis causes
- pathological fracture).
- Remind the client to carry a card identifying the drug being used.
- Stress the need for regular medical supervision.
- Advise the client to delay any vaccination while taking these medications (weakened immunity).
- Explain the need to maintain general hygiene & cleanliness to prevent infection.