Pharmacologic Profile

General Use

Used in replacement doses (20 mg of hydrocortisone or equivalent) systemically to treat adrenocortical insufficiency. Larger doses are usually used for their anti-inflammatory, immunosuppressive, or antineoplastic activity. Used adjunctively in many other situations, including autoimmune diseases. Topical corticosteroids are used in a variety of inflammatory and allergic conditions. Inhaled corticosteroids are used in the chronic management of reversible airway disease (asthma); intranasal and ophthalmic corticosteroids are used in the management of chronic allergic and inflammatory conditions.

General Action and Information

Produce profound and varied metabolic effects, in addition to modifying the normal immune response and suppressing inflammation. Available in a variety of dosage forms, including oral, injectable, topical, ophthalmic, intranasal, and inhalation. Prolonged used of large amounts of topical, ophthalmic, intranasal, or inhaled agent may result in systemic absorption and/or adrenal suppression.

Contraindications

Serious infections (except for certain forms of meningitis). Do not administer live vaccines to patients on larger doses.

Precautions

Prolonged treatment will result in adrenal suppression. Do not discontinue abruptly. Additional doses may be needed during stress (surgery and infection). Safety in pregnancy and lactation not established. Long-term use in children will result in ↓ growth. May mask signs of infection. Use lowest dose possible for shortest time possible. Alternate-day therapy is preferable during long-term treatment.

Interactions

Additive hypokalemia with amphotericin B and potassium-losing diuretics. Hypokalemia may ↑ the risk of digoxin toxicity. May ↑ requirements for insulin or oral hypoglycemic agents. Phenytoin, phenobarbital, and rifampin stimulate metabolism and may ↓ effectiveness. Oral contraceptives may block metabolism. Cholestyramine and colestipol may ↓ absorption.

Nursing Implications

Assessment

• These drugs are indicated for many conditions. Assess involved systems prior to and periodically throughout course of therapy.
• Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) prior to and periodically throughout course of therapy.
• Children should have periodic evaluations of growth during chronic therapy.

Potential Nursing Diagnoses

• Risk for infection (Side Effects)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)
• Disturbed body image (Side Effects)

Implementation

• If dose is ordered daily or every other day, administer in the morning to coincide with the body's normal secretion of cortisol.
• Administer with meals to minimize gastric irritation.

Patient/Family Teaching

• Emphasize need to take medication exactly as directed. Review symptoms of adrenal insufficiency that may occur when stopping the medication and that may be life-threatening.
• Encourage patients on long-term therapy to eat a diet high in protein, calcium, and potassium and low in sodium and carbohydrates.
• These drugs cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious illnesses and to report possible infections. Advise patient to consult health care professional before receiving any vaccinations.
• Discuss possible effects on body image. Explore coping mechanisms.
• Advise patient to carry identification in the event of an emergency in which patient cannot relate medical history.

Evaluation/Desired Outcomes

• Suppression of the inflammatory and immune responses in autoimmune disorders, allergic reactions, and organ transplants.
• Replacement therapy in adrenal insufficiency.
• Resolution of skin inflammation, pruritus, or other dermatologic conditions.