Glucocorticoids Betamethasone (Celestone), cortisone, dexamethasone (Decadron), Hydrocortisone or cortisol (Cortef), hydrocortone, methylprednisolone (Medrol), prednisolone, (Prelone), prednisone (Meticorten), tramcinolone(Kenacort). Glucocorticoids/corticosteroids are used to treat a wide variety of conditions and diseases, such as joint pain, cancer, asthma and allergies. The oral and injected types of corticosteroids form a major part of treatment plans for many chronic pain conditions. Many inflammatory conditions, such as rheumatoid arthritis and gout, are first treated with nonsteroidal anti- inflammatory drugs (NSAIDs). If these drugs do not control the symptoms, corticosteroids are often the next line of treatment. Corticosteroids are a group of anti-inflammatory drugs similar to the hormone cortisol produced in the body. Corticosteroids reduce the inflammation associated with many diseases, including many forms of arthritis. They can be taken in a variety of forms, such as pills, injections, inhalers, nasal sprays, topical creams, drops, ointments, enemas, foams and suppositories. Most corticosteroids are available only with a physician’s prescription. However, your client may use topical creams that are available over the counter. Glucocorticoids, like prednisone and prednisolone, are useful in their ability to inhibit production of inflammatory cytokines and chemokines, reducing the expression of inflammatory molecules, Hydrocortisone enemas are used to maximize effects in the targeted tissue of the rectum and sigmoid colon, and minimize systemic absorption. A controlled-release formula (Entocort) releases the drug in the distal ileum and colon. Glucocorticoids are used to treat moderate to severe active inflammatory bowel disease. Higher dosages risk significantly higher incidence of adverse effects. Oral dosage of prednisone or prednisolone is typically taken daily, once an individual responds to the initial therapy (usually a period of up to two weeks). Dosage is minimized to limit the risk of adverse effects. In very ill patients, intravenous administration may be common. IBD involving the sigmoid colon or rectum is primarily administered rectally to minimize systemic absorption. Orally administered budensonide is slightly less effective than prednisolone in the treatment of active mild or moderate Crohn’s disease affecting the ileum and proximal colon. While achieving slightly less clinical remission, it has significantly fewer side effects. Once remission is achieved, doctors often abandon glucocorticoids in favor of aminosalicylates. Corticosteroids can have a wide variety of serious side effects – particularly when oral forms of the drug are taken for long periods of time. These include acne, weight gain, loss of bone density associated with osteoporosis and decrease in immune response. Many types of medication can interfere with corticosteroids. Corticosteroids are different from the banned anabolic steroids taken by some athletes to enhance performance. Corticosteroids are synthetic versions of the natural hormone cortisol, which is chemically related to the natural hormones produced by the body’s adrenal glands, located at the top of each kidney. Cortisol plays an important role in controlling salt and water balance in the body and regulating carbohydrate, fat and protein metabolism. When the body becomes stressed from infection, trauma, surgery or emotional problems, the adrenal glands produce more cortisol, which helps the body to cope with the stress. When the stress disappears, cortisol production returns to normal. Cortisol also suppresses inflammation, which is the body’s normal response to outside invaders, such as bacteria. Corticosteroids work by blocking the production of substances in the immune system (such as prostaglandins) that trigger allergic and inflammatory reactions. Some autoimmune disorders also trigger inflammation when they react to normal body tissue as if it were an outside invader. Corticosteroids are
strong medications. Although they have proven to be helpful in treating many medical disorders, they have side effects that can be serious. Your client should have discussed the potential risks and benefits with a physician before taking them. Common side effects of corticosteroids include: ● Oral and intravenous: ○ Suppression of the immune system increasing likelihood for infection. ○ Bone loss, which may lead to or exacerbate osteoporosis. ○ Cartilage damage after repeated injections. ○ Acne.
○ Weight gain. ○ Mood swings. ○ Delayed growth (in children). ○ Blurred vision. ○ Frequent urination. ○ Increased thirst. ○ Increased appetite. ○ Indigestion. ○ Flushing of face or cheeks.
● Ointments/drops: ○ Eye infection. ○ Eye pain. ○ Gradual blurring or loss of vision. ○ Nausea/vomiting. ● Inhaled corticosteroids: ○ Sore mouth or throat, hoarseness. ○ Coughing. ○ Thrush (fungus infection in the mouth). ○ Decrease in bone thickness. ○ High blood pressure in the eye or fluid buildup in the eye. ● Nasal spray corticosteroids: ○ Increased chance of bruising. ○ Skin or muscle wasting. ○ Weight gain or fluid retention. ○ Decrease in bone density. ○ Damage to bones and bone cells (avascular osteonecrosis). ○ Increased blood pressure. ○ Increased risk of ulcer. ○ Increased risk of eye complications (e.g. glaucoma, cataracts). ● Topical corticosteroids: ○ Skin blisters fi lled with blood.
○ Itching or burning skin. ○ Increased skin sensitivity. ○ Numbness in the fingers. ○ Increased chance of bruising. ○ Raised red spots on the skin. ● Enemas/foams/suppositories: ○ Burning or itching of skin. ○ Diarrhea. ○ Infection. ○ Rectal bleeding. ○ Sensation of pins and needles.
● Pastes:
○ Infection. ○ Irritation, such as burning, itching, blistering or peeling. Some side effects of corticosteroid drugs are considered more dangerous, though rare. An individual should immediately contact a physician if they experience any of these side effects: ● Blindness. ● Unusual confusion or excitement. ● Hallucinations. ● Mental depression. ● Eye pain. ● Irregular heartbeat. ● Bloody stool. ● Unusual increase in hair growth. ● Vomiting.
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Book Code: MGA1224
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