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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
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,
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).
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
