Corticosteroids Nursing Considerations

Corticosteroids are synthetic drugs that mimic the effects of natural hormones produced by the adrenal glands. They are powerful anti-inflammatory medications that treat various conditions ranging from autoimmune disorders to acute allergic reactions.

Generic names: Prednisone, Methylprednisolone, Hydrocortisone, Dexamethasone, Betamethasone

Brand names: Deltasone, Medrol, Solu-Cortef, Decadron, Celestone

Pharmacologic class: Glucocorticoids

Therapeutic class: Anti-inflammatory agents, Immunosuppressants

Mechanism of action: Corticosteroids suppress the immune system and reduce inflammation. They inhibit the production of inflammatory mediators and decrease the activity of immune cells.

Indications for use: Autoimmune disorders, severe allergic reactions, asthma exacerbations, rheumatoid arthritis, inflammatory bowel disease, skin conditions, organ transplant rejection prevention, certain cancers, and adrenal insufficiency.

Precautions and contraindications: Active infections (especially fungal), live vaccines, diabetes mellitus, osteoporosis, hypertension, glaucoma, peptic ulcer disease, psychiatric conditions, and pregnancy (risk category C).

Drug Interactions

• NSAIDs increase risk of GI bleeding
• Live vaccines may have decreased effectiveness
• Anticoagulants may have increased or decreased effects
• Antidiabetic medications may require dose adjustment
• CYP3A4 inducers/inhibitors can affect corticosteroid metabolism

Adverse Effects

• Cushing’s syndrome (moon face, buffalo hump)
• Increased blood glucose levels
• Osteoporosis and increased fracture risk
• Immunosuppression and increased infection risk
• Mood changes, anxiety, depression
• Insomnia
• Hypertension
• Delayed wound healing
• Cataracts and glaucoma
• Adrenal suppression
• Muscle weakness
• Skin thinning and easy bruising
• Growth suppression in children

Administration Considerations

Available preparations: Oral tablets, intravenous solutions, topical preparations (creams, ointments), inhalers, nasal sprays, and ophthalmic preparations.

General dosing principles: Dosing varies widely based on condition, severity, and route of administration. Always use the lowest effective dose for the shortest duration possible.

Nursing Considerations for Corticosteroids

Related Nursing Diagnoses

• Risk for infection
• Risk for impaired skin integrity
• Disturbed sleep pattern
• Risk for unstable blood glucose
• Anxiety
• Risk for injury related to osteoporosis

Nursing Assessment

1. Complete health history including current infections, diabetes, osteoporosis, and psychiatric conditions
2. Baseline vital signs, especially blood pressure and blood glucose
3. Skin assessment for integrity, bruising, and existing infections
4. Current medication list to identify potential interactions
5. Mental status and mood assessment

Nursing Interventions

1. Monitor vital signs, blood glucose, and electrolytes regularly
2. Implement infection prevention measures
3. Assess for signs of Cushing’s syndrome
4. Monitor for mood changes and sleep disturbances
5. Implement fall precautions due to muscle weakness
6. Monitor for signs of GI bleeding
7. Never discontinue corticosteroids abruptly; follow the tapering schedule

Patient Teaching Associated with Corticosteroids

• Take oral corticosteroids with food to minimize GI upset
• Do not stop medication abruptly; follow the prescribed tapering schedule
• Wear medical alert identification
• Report signs of infection promptly (fever, sore throat, cough)
• Monitor blood glucose if diabetic
• Practice good infection prevention (hand hygiene, avoiding sick contacts)
• Implement lifestyle modifications:
  • Regular exercise to prevent muscle weakness and bone loss
  • Adequate calcium and vitamin D intake
  • Low-sodium diet to prevent fluid retention
  • Regular blood pressure monitoring

• Schedule routine eye examinations
• Report any unusual mood changes or sleep disturbances
• Use protective measures to prevent skin injury

Note: This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult with a pharmacist for complete information.

References

1. Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y, Pirracchio R, Rochwerg B. Corticosteroids for treating sepsis in children and adults. Cochrane Database Syst Rev. 2019 Dec 6;12(12):CD002243. doi: 10.1002/14651858.CD002243.pub4. PMID: 31808551; PMCID: PMC6953403.
2. Bartsch, R., Aletaha, D., Fuereder, T., Aapro, M., Jornayvaz, F. R., Lang, P., Migliorini, D., Csajka, C., Aretin, M., & Dougoud-Chauvin, V. (2024). Corticosteroid therapy in older adults with cancer: Expert recommendations from a task force of the International Society of Geriatric Oncology. Journal of Geriatric Oncology, 102077. https://doi.org/10.1016/j.jgo.2024.102077
3. Kapugi M, Cunningham K. Corticosteroids. Orthop Nurs. 2019 Sep/Oct;38(5):336-339. doi: 10.1097/NOR.0000000000000595. PMID: 31568125.
4. Stacey SK, McEleney M. Topical Corticosteroids: Choice and Application. Am Fam Physician. 2021 Mar 15;103(6):337-343. PMID: 33719380.
5. Stern A, Skalsky K, Avni T, Carrara E, Leibovici L, Paul M. Corticosteroids for pneumonia. Cochrane Database Syst Rev. 2017 Dec 13;12(12):CD007720. doi: 10.1002/14651858.CD007720.pub3. PMID: 29236286; PMCID: PMC6486210.