McKenna's Pharmacology for Nursing, 2e

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P A R T 6  Drugs acting on the endocrine system

Safe medication administration

Adverse effects of corticosteroid use associated with various routes of administration Systemic: Systemic effects are most likely to occur when the corticosteroid is given by the oral, intravenous, intramuscular

decreased carbohydrate tolerance, glucose dysregulation and/or diabetes. Other: immunosuppression, aggravation or masking of infections, impaired wound healing, suppression of hypothalamic–pituitary axis. Intramuscular repository injections: atrophy at the injection site. Retention enema: local pain, burning; rectal bleeding. Intra-articular injection: osteonecrosis, tendon rupture, infection. Intraspinal: meningitis, adhesive arachnoiditis, conus medullaris syndrome. Intrathecal administration: arachnoiditis. Topical: local burning, irritation, acneiform lesions, striae, skin atrophy. Respiratory inhalant: oral, laryngeal and pharyngeal irritation; fungal infections. Intranasal: headache, nausea, nasal irritation, fungal infections, epistaxis, rebound congestion, perforation of the nasal septum, anosmia (lack of ability to perceive odours), urticaria. Ophthalmic: infections, glaucoma, cataracts. Intralesional: blindness when used on the face and head (rare).

or subcutaneous route. Systemic absorption is possible, however, if other routes of administration are not used correctly or if tissue breakdown or injury allows direct absorption. Central nervous system: vertigo, headache, paraesthesias, insomnia, convulsions, psychosis. Gastrointestinal: peptic or oesophageal ulcers, pancreatitis, abdominal distension, nausea, vomiting, increased appetite, weight gain. Cardiovascular: hypotension, shock, heart failure secondary to fluid retention, thromboembolism, thrombophlebitis, fat embolism, arrhythmias secondary to electrolyte disturbances. Haematological: sodium and fluid retention, hypokalaemia, hypocalcaemia, increased blood sugar, increased serum cholesterol, decreased thyroid hormone levels. Musculoskeletal: muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, spontaneous fractures. Eyes, ears, nose and throat: cataracts, glaucoma. Dermatological: frail skin, petechiae, ecchymoses, purpura, striae, subcutaneous fat atrophy. Endocrine: amenorrhoea, irregular menses, growth retardation, Prototype summary: Prednisone Indications: Replacement therapy in adrenal cortical insufficiency, short-term management of various inflammatory and allergic disorders, hypercalcaemia associated with cancer, haematological disorders, ulcerative colitis, acute exacerbations of multiple sclerosis, palliation in some leukaemias, trichinosis with systemic involvement. Actions: Enters target cells and binds to intracellular corticosteroid receptors, initiating many complex reactions responsible for its anti-inflammatory and immunosuppressive effects. Pharmacokinetics: Route Onset Peak Duration PO Varies 1–2 hours 1–1.5 days T 1/2 : 2–3 hours; metabolised in the liver to the active metabolite prednisolone and excreted in the urine. Adverse effects: Vertigo, headache, hypotension, shock, sodium and fluid retention, amenorrhoea, increased appetite, weight gain, immunosuppression, aggravation or masking of infections, impaired wound healing.

Care considerations for people receiving glucocorticoids

Assessment: History and examination

■ ■ Assess for history of allergy to any steroid

preparations, acute infections, peptic ulcer disease, pregnancy, breastfeeding, endocrine disturbances and renal dysfunction, which could be cautions or contraindications to use of the drug . ■ ■ Assess weight; temperature; orientation and affect; grip strength; eye examination; blood pressure, pulse, peripheral perfusion and vessel evaluation; respiration and adventitious breath sounds; glucose tolerance, renal function, serum electrolytes and endocrine function tests as appropriate, to determine baseline status before beginning therapy and for any potential adverse effects . Refer to the Critical thinking scenario for a full discussion of care for a person who is receiving glucocorticoids. Implementation with rationale ■ ■ Administer drug daily at 8 to 9 a.m. to mimic normal peak diurnal concentration levels