Steroid Pharmacology: Corticosteroids in a Nutshell

We’ve mentioned before in a summary lecture of our respiratory drugs the two main categories – BAM and SLM. B-A-M are the bronchodilators, and S-L-M are anti-inflammatories.

In this article, we’ll be discussing the “S” in our SLM category. The “S” stands for steroids, or it can also be referred to as Solu-Medrol, which is a brand name for methylprednisolone, and the suffix “-son” or “-sone.”

Let’s begin.

The Corticosteroids Team

Corticosteroid medications usually end in either “-son” or in “-sone.” So, this tip alone can help you remember that drugs having those two suffixes are corticosteroids. Some examples would be prednisone and methylprednisolone (Solu-Medrol).

Mechanism of Action

Corticosteroids help to relieve the lungs of inflammation.

So, going back to the lungs’ anatomy, we know that inside the lungs are branches called bronchi which extend to smaller branches called bronchioles. At the end of these bronchioles are alveoli. Inside these alveoli, a lot of issues can arise.

When there is inflammation along the branches of the lungs, this results in:

  • Backing up of airflow
  • No airflow at all

Therefore, if there are a lot of inflammation happening inside the lungs, the client will get suffocated.

Remember that oxygen is the currency used by the body to live. Without proper access to airflow, there will be no oxygen, and without oxygen, the body becomes broke and dies. Always remember that nine out of 10 issues inside the body are always related to the lack of oxygen.

Corticosteroids are primarily given to give the lungs sufficient oxygen access.

The Inflammation Process

The inflammation process usually happens due to the presence of prostaglandins and histamines. Histamines cause the allergic reaction while prostaglandins cause the pain. The other causes of inflammatory responses are:

  • Substance P
  • COX-1 and COX-2

The worst part about having an allergic reaction is that the body will experience numerous responses wherein the abovementioned elements will immediately react and cause the different manifestations of inflammation.

Adrenal Insufficiency

During an inflammatory response, the adrenal glands usually step up to go against the inflammation and decrease the reaction. However, there will be moments of adrenal insufficiency wherein the adrenals are over-fatigued. This happens when there’s just too much inflammation than the adrenals can tolerate.

The adrenals will do the best they can to fight the inflammation but sometimes, the reaction is so severe that the adrenals can no longer take it.

During episodes of adrenal insufficiency, clients are given albuterol to help get the prednisone down into the lungs for better absorption. Albuterol is used to dilate the branches of the lungs.

The Last Line of Therapy

Corticosteroids are considered the last drugs a respiratory client will receive after receiving other medications. Mostly, inflammatory conditions like COPD are given steroids.

Remember that steroids act slower, but the effects are more extensive.  

Side Effects

Every drug has a side effect. As for corticosteroids, one of the major side effects, that is also a favorite topic during nursing exams, is immunosuppression. Corticosteroids like prednisone will suppress the immune system which means that the drug is bound to kill off the white blood cells in the body, like what is happening with chemotherapy.

Other side effects that you have to watch-out-for with clients taking corticosteroid are the following:

  • Increased blood sugar
  • Fluid retention
  • Increased muscle weakness
  • Potassium loss

There you have it, corticosteroids in a nutshell. For our next lecture, we’ll be focusing on leukotrienes and Singulair.

Renal Disorder: What is Nephrotic Syndrome (Nephrosis)?

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Nephrotic syndrome, also known as nephrosis, is considered as one of the major, essential subjects in nursing school. After this, we’ll go into acute glomerulonephritis.

The Nerf Balls

As a kid, you’ve encountered a Nerf toy that is loaded with Nerf balls. When connecting nephrotic syndrome or nephrosis to a Nerf toy, think of the Nerf balls because as the kidney becomes inflamed, the glomeruli become increasingly permeable and the protein (Nerf balls) go through the glomeruli and then goes out from the body through the urine.

Therefore, when talking about the nephrotic syndrome, you always have to keep in mind that the primary element affected will be protein. This is really important especially when you are taking an important nursing exam like the NCLEX®.

Inflamed Kidneys

A human’s kidneys have functional structures known as nephrons, which are primarily responsible for the production of urine. Inside these nephrons are glomeruli that are tasked with filtering hydrogen, urea nitrogen, and creatinine (a by-product of protein) or what we refer to as the acronym, HUC. This situation is supposed to be the normal process of filtering blood, retaining water, and eliminating toxins and wastes from the body.

When your client has an inflamed kidney, the glomerulus becomes a tight mesh, similar to that of a coffee filter or a huge, permeable chain-link fence wherein you can easily push things through it.

Protein, in the form of albumin or creatinine, leaks into the urine. The main indicator of nephrosis is increased protein in a client’s urine output. However, this does not necessarily state that every time creatinine is increased, it’s immediately a sign of nephrosis.

Nephrotic Syndrome: Pathophysiology

Nephrosis is an autoimmune disorder, which means that the condition is of genetic predisposition wherein the body is attacking itself. Here, the body attacks its glomeruli, resulting to inflammation and permeability. Other examples of autoimmune disorders are Parkinson’s disease and Lupus.

During the attack, the body will experience remissions and exacerbations which are due to three S’s – sepsis, stress, and smoking. Infection is another predisposing factor for a flare-up or an exacerbation.

As mentioned, once the glomeruli are inflamed, they become very permeable that there will be increased protein/albumin elimination in the urine.

Nephrotic Syndrome and Edema

Fluid retention causes edema in nephrotic syndrome. How?

Remember that the kidneys are supposed to filter blood and eliminate urine. If the glomeruli become permeable, they will not filter and will retain an increased amount of fluid; this will lead to fluid retention, and the consequence is edema. And if there’s edema, you can expect high blood pressure or hypertension, which is also a considerable risk factor for clients with nephrotic syndrome.

Managing Nephrosis

If you have a client who has nephrosis, there are a couple of ways to manage the condition. The priority is to get rid of the inflammation of the glomeruli while getting rid of the edema.

Aside from client education, medication is advised. What are the usual types of medications given to clients with nephrotic syndrome?

  1. Steroids

Prednisone is the steroid of choice for clients experiencing nephrosis. Prednisone helps in bringing down systemic inflammation. These are not the kind of steroids used by bodybuilders but the ones naturally produced by the adrenal cortex to stop inflammation inside the body.  

  1. Glucocorticosteroids

Another type of medication used for nephrotic syndrome clients is glucocorticosteroids; however, the use of this type of medication makes the client more predisposed to infections and edema. The solution for the edema side effect will be tackled on the next kind of medication.

  1. Diuretic

After managing glomeruli inflammation, the next thing that you want to take care of is the fluid retention which causes edema. As you are aware, there are four different types of diuretics, namely:

  • Osmotic diuretic
  • Potassium-sparing diuretic
  • Loop diuretic
  • Thiazide diuretic

Among these types of diuretics, there’s only one given with clients who have nephrosis, and that is thiazide diuretic.

Thiazide diuretics act on the descending loops of Henle, which is just a fancy word for the tubes inside the kidneys. Thiazides are used instead of the other kinds of diuretics because:

  • It is not potassium-wasting like that of furosemide (Lasix)
  • It does not bring down osmolality or the pressure in the bloodstream
  • It is not potassium-sparing like that of spironolactone

For those who are interested in a more detailed explanation of these types of diuretics, we have an entire lecture dedicated to this topic. You can check that out in SimpleNursing’s YouTube channel or look it up on our website.

Important Pointers

So, here’s a quick summary of what we’ve tackled:

  1. The primary problem with nephrotic syndrome or nephrosis is glomerular inflammation.
  2. The primary indication of nephrosis is increased protein excretion, evident in the urine.
  3. Glomeruli membranes become very permeable.
  4. Managing glomerular inflammation is through the administration of steroids.
  5. Managing edema is through thiazide diuretics.

As promised, our next topic will be glomerular nephritis. Please check this out on our next article by going to SimpleNursing.com.