Asthma Pharmacology & Steroids Nursing Introduction 

Steroids are a class of hormones produced by the adrenal gland that plays a significant role in regulating how the body responds to stress. There are two main types of steroids; glucocorticoids and mineral corticoids. Corticosteroids are characterized by mineralocorticoid and glucocorticoid effects.

Glucocorticoids

Glucocorticoids are a class of steroid hormones produced in the adrenal cortex. They have many functions, including regulating metabolism and immune function. They are produced by the adrenal gland and have many effects throughout the body. In addition to their endocrine activity, glucocorticoids also have critical local effects on specific tissues.

The most common use for glucocorticoids is to treat inflammation related to autoimmune disorders like lupus and rheumatoid arthritis. They can also be used to treat: 

• Asthma attacks
• Chronic obstructive pulmonary disease (COPD)
• Allergies
• Inflammatory bowel disease (IBD)
• Crohn’s disease
• Ulcerative colitis
• Other inflammatory conditions (that affect the gastrointestinal tract)

Glucocorticoids Mechanism of Action

Glucocorticoids influence or regulate functions such as the immune response (glucose, fat, and protein metabolism), and the anti-inflammatory response. Glucocorticoids enter target cells and bind to receptors, initiating many complex reactions in the body.

Glucocorticoid Indications

• Adrenocortical insufficiency (replacement therapy)
• Allergic reactions
• Collagen diseases (e.g., systemic lupus erythematosus)
• Dermatologic conditions
• Rheumatic disorders
• Shock

Glucocorticoid Contradictions

Glucocorticoids are administered with caution to clients with: 

• Renal or hepatic disease
• Hypothyroidism
• Ulcerative colitis
• Diverticulitis
• Peptic ulcer disease
• Inflammatory bowel disease
• Hypertension
• Osteoporosis
• Convulsive disorders
• Diabetes

Also, clients taking adrenocorticotropic hormone (ACTH) should avoid any vaccinations with live viruses. The live virus vaccines can potentiate virus replication with ACTH, increase any adverse reaction to the vaccine, and decrease the client’s antibody response to the vaccine.

Glucocorticoid Nursing Interventions

With these nursing interventions, keep in mind that glucocorticoids threaten adrenal gland insufficiency for clients.

Avoid

• Skipping a dose of a glucocorticoid (for client).
• Suddenly discontinuing glucocorticoid therapy.

Administer

• Drugs exactly as directed in the prescription container. Do not increase, decrease, or omit a dose unless advised.
• Doses before 9:00 a.m.

Provide

• Adjustments of insulin or antidiabetic drug dosage for clients with diabetes.

Prednisone Nursing Considerations

Prednisone is a corticosteroid used to treat a wide range of conditions, from arthritis to asthma. This medication is not without risks, and there are some vital considerations for nursing staff when administering the drug.

Prednisone has been shown in studies to affect bone density. Additionally, prednisone can cause weight gain and mood swings — both of which can be dangerous side effects if left untreated. Nurses must educate clients regarding risks and side effects.

Dexamethasone Nursing Considerations

Dexamethasone is a drug that is prescribed for inflammation, swelling, and other symptoms associated with a variety of conditions. This medication can be given as an oral tablet, an intramuscular injection, and intravenously.

Dexamethasone can increase blood glucose levels. Therefore, it should be used carefully in people with diabetes or other blood sugar issues.

This medication should be used with caution in individuals with hypertension as it is known to increase blood pressure.

Hydrocortisone Nursing Considerations

Hydrocortisone is a powerful and fast-acting corticosteroid. It is used to treat eczema, psoriasis, and atopic dermatitis. It can be prescribed as an oral medication or topical cream. It reduces inflammation in the skin by suppressing the immune system.

As a nurse, you should educate clients to take their medication exactly as prescribed to decrease the risk of serious side effects. Known side effects are thinning skin, stretch marks, or even cataracts.

Fludrocortisone Nursing Considerations

Fludrocortisone is a synthetic mineralocorticoid used to increase blood pressure in clients with Addison’s disease. It can also be used in other cases of adrenal insufficiency, including Conn’s syndrome (primary aldosteronism, a rare condition caused by overproduction of the hormone aldosterone that controls sodium and potassium in the blood).

Fludrocortisone has several potential side effects, including weight gain and electrolyte disturbances. Clients should be monitored closely for these and other side effects while taking this medication.

Anabolic Steroids

The use of anabolic steroids to promote an increase in muscle mass and strength (cosmetically) has become a serious problem. According to the US National Institute on Drug Abuse, “The vast majority of people who misuse steroids are male non-athlete weightlifters in their 20s or 30s”.1

Unfortunately, deaths in young individuals have been directly attributed to the use of these drugs. Misuse should be discouraged from the illegal use of anabolic steroids to increase muscle mass.

Anabolic Steroid Mechanism of Action

Anabolic steroids are synthetic drugs chemically related to androgens. Like the androgens, they promote tissue-building processes. 

Anabolic Steroid Adverse Reactions

The term “anabolic steroid” refers to synthetic compounds that mimic the effects of testosterone. It can act as a performance enhancer and a muscle-building supplement. But because of these dangerous side effects, the use of anabolic steroids is banned by most governing bodies in sports.

Anabolic steroids can also come with adverse health effects, including:

• Hypersensitivity
• Liver tumors and/or toxicity
• Cardiac disease
• Prostate gland disorders
• Testicular atrophy
• Nausea & vomiting
• Fluid and electrolyte imbalances
• Jaundice
• Anorexia
• Blood-filled cysts of the liver (and sometimes the spleen)
• Increased risk of atherosclerosis
• Mental changes

Anabolic Steroid Indications

Anabolic steroid use includes the following:

• Management of anemia of renal insufficiency
• Control of metastatic breast cancer 
• Promotion of weight gain in those with weight loss after surgery, trauma, or infections

Anabolic Steroid Nursing Interventions

Keep in mind that sodium and water retention may also occur with androgen or anabolic steroid administration, causing the client to become edematous.

Assess 

• Client’s physical and nutritional status (before starting steroid therapy)

Monitor

• Clients for fluid and electrolyte disturbances, as well as nausea and GI upset.

Perform

• Labs that include a complete blood count, hepatic function tests, serum electrolytes, and serum lipid levels.

Asthma Pharmacology

Asthma is a chronic inflammatory disorder in the major airways of the lungs: bronchi and bronchioles. Asthma comes and goes with flare-ups in the form of asthma attacks, but these can be reversed with the right drugs.

And it’s important to note that asthma clients should not use NSAIDs and Beta-blockers.

Memory Trick – AIM for Acute Asthma Attack

• Albuterol – first
• Ipratropium – second
• Methyl-predniso-lone (brand: Solu Medrol)

Beta 2 Agonists (Bronchodilators) 

To increase oxygen supply to asthma clients, bronchodilators are administered to dilate the big branch or big stump inside the lungs that lead to the bronchioles. Once these “highways” are opened up, more oxygen can travel down them.

The bronchodilator team consists of beta2-agonists. The names of these usually end in “-terol” like Albuterol.

Memory Trick

• Buterol
• Brutal Asthma Attacks

Understanding the body lies in its internal receptors. These receptors, called beta receptors, can also be called “sympathomimetic” or “fight and flight” receptors because they send signals to the brain when activated by drugs.

The fight-or-flight response is a term used to describe what happens when you’re faced with a stressful situation. For example, when you’re running from a bear, your body deals with that threat by increasing heart and breathing rates.

Memory Trick

• Beta 2 Agonist (Albuterol)
  • Think buterols for brutal asthma attacks. It’s considered the one and only rescue drug for asthma attacks.
• Anticholinergics (Ipratropium)
  • Dries out the body, decreasing secretions, and dilating the airways.
• Methylxanth (Theophylline)
  • Very toxic and very fast HR (10 – 20 therapeutic range).

Albuterol

Albuterol is the type of medication that can help a client during crisis or rescue situation, similar like fast-acting insulins. Albuterol is the only rapid-acting respiratory drug.

Steroids & Asthma Pharmacology Conclusion

The adrenal gland produces a group of hormones known as steroids, which are important in controlling how the body reacts to stress. Both glucocorticoids and corticosteroids perform comparable tasks, such as regulating blood sugar, supporting the immune system, and reducing inflammation all over the body.

However, they operate differently – corticosteroids affect all organs, whereas glucocorticoids affect the kidneys.

Synthetic medications known as anabolic steroids share a chemical structure with androgens. They support processes that grow tissue, just like androgens do.

Glucocorticoids serve a variety of purposes, including controlling immunological and metabolic processes. They are created by the adrenal gland and have a variety of physiological consequences. 

Sources

1https://nida.nih.gov/publications/research-reports/steroids-other-appearance-performance-enhancing-drugs-apeds/who-uses-anabolic-steroids 

https://medlineplus.gov/anabolicsteroids.html 

​​https://my.clevelandclinic.org/health/drugs/4812-corticosteroids 

http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/adrenal/gluco.html